Chelsea Skilled Nursing and Rehabilitation

Chelsea Skilled Nursing and Rehabilitation

MI Elder Abuse Free Legal ConsultationDid someone you love suffer elder abuse or neglect at Chelsea Skilled Nursing and Rehabilitation? 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 Chelsea Skilled Nursing and Rehabilitation

Chelsea Skilled Nursing and RehabilitationChelsea Skilled Nursing and Rehabilitation is a for profit, 82-bed Medicare/Medicaid certified skilled nursing facility that provides services to the residents of Chelsea, Boston, Everett, Revere,  Winthrop, and the other towns in and surrounding Suffolk County, Massachusetts.

Chelsea Skilled Nursing and Rehabilitation focuses on 24 hour care, respite care, hospice care and rehabilitation services.

Chelsea Skilled Nursing and Rehabilitation
932 Broadway
Chelsea, MA 02150

Phone: (617) 889-2250
Website: http://www.genesishcc.com/Chelsea

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, Chelsea Skilled Nursing and Rehabilitation in Chelsea, Massachusetts received a rating of 1 out of 5 stars.

Performance Area Rating
Overall Rating 1 out of 5 (Much Below Average)
State Health Inspections 1 out of 5 (Much Below Average)
Staffing 3 out of 5 (Average)
Quality Measures 3 out of 5 (Average)

Fines Against Chelsea

The Federal Government fined Chelsea Skilled Nursing and Rehabilitation $33,878 on December 7th, 2016 and $23,238 on December 17th, 2015 for health and safety violations.

Fines and Penalties

Our Nursing Home Injury And Elder Abuse Lawyers inspected government records and discovered Chelsea Skilled Nursing and Rehabilitation committed the following offenses:

Failed to listen to the resident or family groups or act on their complaints or suggestions.

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

Based on observation review of the Resident Council minutes and Resident interview the facility failed to act upon a grievance which was voiced at Resident Council Meetings for 3 months, for 1 resident (Resident #10) in a total sample of 15 residents.

Findings include:

The Surveyor reviewed 3 months of Resident Council Minutes, which indicated that the residents complained of the nursing staff not identifying themselves to the residents as their caregivers.

* 9/30/16 Resident Council Minutes indicated that resident had requested a daily log of Certified Nursing Assistants (CNAs) assigned to their personal care in their room.

* 10/28/16 Resident Council Minutes indicated that prior meeting minutes were reviewed (this included the above information). It further indicated that Aides will introduce themselves to residents daily.

* 11/18/16 Resident Council Minutes indicated (Request to have daily log of CNAS in rooms) Residents aware that aides will introduce themselves to residents daily. This was the third month this concern was identified by the residents and there still was no resolution identified to address the issue effectively.

1. Resident #10 was admitted to the facility in 7/2016 with [DIAGNOSES REDACTED]. The resident is alert and oriented.

On 12/01/16 at 9:40 A.M., the resident was observed lying in bed. The resident said he/she would like to say a few things to the Surveyor. He/she said that he/she did not know who was taking care of him/her that morning and as a result he/she was angry and upset. I have been awake since 7:00 A.M., and I would like to get up so I can go to the day room and do my word search puzzle. I have no idea who is taking care of me today as no one has come in to tell me It happens all the time. He/she said that he/she has complained to nursing staff that certified nurse aides (C.N.A.s) do not identify themselves to him/her as his/her caregiver at the beginning of each shift. He/she said that he/she was told by staff that the C.N.A.s are supposed to identify themselves to him/her at the beginning of each shift. He/she further said that the Administrator told him/her that the C.N.A.s are supposed to introduce themselves to him/her. At that moment, a C.N.A. knocked on the door and entered the resident’s room. The C.N.A. looked at the resident and walked by the resident’s bed without speaking to him/her. The resident asked the C.N.A. if she was assigned to take care of him/her and the C.N.A. responded, no. The resident said, So you’re not assigned to me today? I want to get out of bed and I don’t know who is assigned to me. Do you know who is supposed to take care of me? It’s not you? The C.N.A. then smiled, nodded her head, pointed to herself and said, me. The resident asked, So it is you? The C.N.A. said yes. The C.N.A. then left the room for a moment. The resident then said to the Surveyor, Are you kidding me? Did you just see that? She took care of my roommate and got (him/her) out of bed earlier this morning. She has been in my room three times today and she never told me she was my aide. I am really upset. The aide returned shortly thereafter and provided the resident with care.

Failed to develop a complete care plan that meets all of a resident's needs, with timetables and actions that can be measured.

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

Based on record review and staff interview, the facility failed to develop a comprehensive care plan for 2 residents (Resident # 6 and Resident #12), out of a total sample of 15 residents.

Findings include:

1. For Resident #6, The facility failed to develop a care plan to address the resident’s desire to do his own treatment and refusal of having facility staff do so, for the care of his/her long standing cyst; as well as managing and working with the resident relative to related infection control issues.

Resident #6 was admitted to the facility in 9/13/16 with a [DIAGNOSES REDACTED]. Review of the admission Minimum Data Set assessment (MDS), dated [DATE], indicated that the Resident had scored an 11 out of a 15 on a cognitive test which determined the Resident to have moderate cognitive impairment. The MDS also indicated that the Resident was able to be independent in most activities of daily living except for bathing and grooming.

On 12/2/16 at 11:00 A.M., the Surveyor interviewed Resident #6 while in his/her bedroom. The Resident was friendly and engaged in conversation. The Resident’s room was cluttered of his/her own choosing. There was no additional chair to sit on so the Resident offered the Surveyor the bed to sit on. It was then when the Surveyor noticed the sheets that the Resident was sitting on had visible stains of red blood and yellow drainage. When the Surveyor asked the Resident what that was he/she said that they had had a cyst on the buttocks area that was leaking. The Resident was quite proud to say how the bandage gets changed. He/she said that the nurses do not do it, but the Resident does by putting an a dry pad on the inside to his/her jeans and pulls up the pants hoping the bandage holds to the area. The Resident did ask the Surveyor if she wanted to look at the wound. The Resident all of a sudden jumped up off the bed saying that he/she would be right back after a cigarette break. The Resident had his hand on the dirty linen, did not wash his/her hands and walked out of the room.

A review of the Nurses Progress notes on 12/8/16 at 10:10 A.M., indicated that with the exception of the Resident showing the area to a few nurses, the resident would refuse to have staff care for the wound.

On 12/7/16, at 2:45 P.M., Review of the facility’s care plans for Resident #6, indicated that the resident had a history, dating back before the Resident was accepted for admission, of refusing care on what is described as a cyst in the buttock area seeping serosangeous fluids on the Resident’s bed linen, hands and clothes. The Resident’s care plans indicated that the Resident was at risk for infection due to a cyst on the buttocks area. It indicated that the Resident refused to allow nursing personel to treat or assess the area. There was no mention of the resident having [MEDICAL CONDITION] in the care plan and did not outline the risks it could pose to other residents and the staff. The interventions were:

  • Assess the characteristics of urine.
  • Assist the resident with hand washing throughout the day as needed.
  • Monitor for signs and symptoms of infections and report them to the physician as indicated.

Obtain labs/cultures as ordered and report results to the physician. Review of the record indicated no other plans for working with the resident with regard to his refusal of staff care, working with the resident regarding self-care for the cyst and management of the related potential infection control issues. Additional information, check ups and new care plans were put in place subsequently to the Surveyors inquiry.

2. For Resident #12, the facility failed to develop a care plan for new onset of pain presence.

Resident #12 was admitted to the facility in 8/2016, with [DIAGNOSES REDACTED]. On 12/6/16, review of Resident #12’s clinical record indicated that the resident was complaining of increased tooth pain as of 11/7/16 and had last been seen by the dentist on 11/15/16. The Dentist’s note indicated that the resident requested to have the painful tooth extracted. The Dentist ordered [MEDICATION NAME] 5/325, (12 tablets) 1 tablet every 4 hours as needed for pain. Further review of the November medication administration record indicates that the [MEDICATION NAME] order was never added to the Resident MAR and there is no indication the physician was notified of the [MEDICATION NAME] recommendation.

On 12/6/16, review of the Resident care plans indicated that the treatment for [REDACTED].

In an interview on 12/7/16, at 11:15 A.M. with the MDS Coordinator, she said that she didn’t know why a care plan wasn’t developed for pain for this resident after the quarterly MDS was completed and indicated pain was found to be a significant problem for the resident.

In an interview on 12/7/16, at 11:30 A.M., with the Director of Nursing (DON), the DON said that when a new issue was identified, such as increased pain, the nursing staff is responsible for creating a care plan.

Failed to provide necessary care and services to maintain the highest well being of each resident

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

Based on record review, interview and observation, the facility failed to identify, assess and provide care for and/or delayed treatment in 3 of 15 sampled residents (Resident #3, Resident #6 and Resident #12).

Findings include:

1. For Resident #3, the facility failed to identify, assess and treat two new unstagable arterial/pressure wounds to Resident #3’s right lower leg. Resident #3 was admitted to the facility in 3/2015, with [DIAGNOSES REDACTED]. The quarterly Minimum Data Set (MDS) assessment dated [DATE], indicated the resident had a Brief Interview for Mental Status (BIMS) assessment score of 15 out of 15 (the resident was cognitively intact). In addition, the resident required extensive assist for bed mobility, dressing, toilet use, and bathing. Furthermore, the Resident was non-ambulatory and required a mechanical lift to transfer from bed to chair and had a stage 4 chronic ischial wound.

Record review on 12/01/16 indicated a Norton Plus Pressure Ulcer Scale dated 11/24/16, resulted in a score of 7, indicating a high risk for the development of skin breakdown. Review of the physical therapy treatment encounter/progress notes dated 11/15/16 to 12/29/16 indicated:

  • 11/18/16 the physical therapy assistant had informed/spoke to the nurse on duty about Resident #3’s new openings on the right knee.
  • 11/22/16 positioning in bed for improved pelvis position to decrease pressure to right knee due to pressure sore.
  • 11/23/16 positioning in bed to decrease pressure to right knee and improve healing to pressure sores.
  • 11/24/16 positioning in bed to improve posture and decrease pressure to right knee.
  • 11/25/16 educated certified nursing assistant about positioning in bed to prevent further pressure sore on right lateral leg, nursing aware of sores.
  • 11/26/16 patient positioned in bed to decrease pressure on sores on right lateral leg.
  • 11/30/16 patient found once again in right wingswept pelvis position with all pressure on right lateral leg which has 2 new wounds.
  • 11/15/16 to 11/28/16 weekly progress note indicated . patient is consistently found positioned in windswept pelvis position to her right side with all pressure on her right lateral knee.
  • 11/30/16 to 12/29/16 weekly progress note indicated . patient with a new wound on her right lateral knee, however, patient is consistently found positioned in wingswept pelvis position to her right side with all pressure on right side of her lateral knee.

During an interview with the physical therapy assistant on 12/6/16 at 10:45 A.M., she said she notified the nursing staff about a week ago of the new pressure areas on Resident #3’s right leg. The therapist said she provided a wedge and pillow for positioning of the right leg, and educated the staff on the use of the wedge and pillow for positioning. She additionally said, nothing changed. When the surveyor asked the therapist what she meant, she said it took about a week and a half for the staff to start using the items provided and covering the wounds with a dressing.

During an interview with Residents #3’s husband on 12/6/16 at 10:50 A.M., he said the physical therapist found the new wounds and notified the nursing staff, he further said no one applied treatments to the areas until he went to the nurse’s desk himself and inquired. He said this was approximately a week after the wounds were identified.

Review of the nurses progress notes from 11/17/16 to 11/28/16, indicated there was no evidence of documentation of the new wounds until 11/28/16, when a change in skin integrity note and report was completed. This documentation indicated a right lateral knee and calf pressure area with eschar (black, dead tissue). Despite the physical therapist informing nursing of the new arterial/pressure ulcers on 11/18/16, there was no evidence the physician was notified nor was a treatment prescribed until 11/28/16.

In an interview with the wound nurse on 12/1/16 at 4:10 P.M., the wound nurse said she was unaware of Resident #3’s unstagable arterial/pressure ulcers until 11/28/16. She told the surveyor that the wounds were necrotic when found, and this should not have happened. The wound nurse asked the surveyor to speak to the Director of Nurses (DON). The DON said she investigated Resident #3’s wounds and was unable to find out from the staff why the areas were not identified,assessed and treated until 11/28/16.

Observation of Resident #3’s wounds by the surveyor on 12/2/16 at 11:30 A.M., revealed a right knee and right calf wound, unstagable with yellow/white tissue (slough) adhering to the wound bed with moderate amount of serous drainage. Wounds measure, approximately 1.5 x 1.5 centimeters each. Prescribed treatment at this time was Santyl ointment a chemical wound debrider to rid the wound of dead tissue.

2. For Resident #12, the facility failed to assess resident for new onset of pain and delayed treatment to provide relief from pain.

Resident #12 was admitted to the facility in 8/2016, with [DIAGNOSES REDACTED]. On 12/6/16, review of the quarterly Minimum Data Set ((MDS) dated [DATE], indicated that the resident received a scheduled pain medicine regimen and received pain medication as needed. The pain assessment indicated that the resident has pain presence frequently which makes it difficult for Resident #12 to sleep and limits the Resident’s day-to-day activities.

On 12/6/16, the 11/2016 Medication Administration Record (MAR) and 12/2016 MAR were reviewed and indicated that the resident was receiving:

  • [MEDICATION NAME] HCL IR 5 milligram (MG) tablet every day at 8:00 A.M.
  • [MEDICATION NAME] HCL IR 10 MG at bedtime.
  • [MEDICATION NAME] HCL IR: 5 MG as needed twice a day.
  • [MEDICATION NAME] 325 MG as needed.
  • [MEDICATION NAME] 600 MG every 6 hours, as needed, for tooth ache.

On 12/6/16, review of Resident #12’s clinical record indicated that the resident was complaining of increased tooth pain as of 11/7/16 and had last been seen by the Dentist on 11/15/16. The Dentist’s note indicated that the resident requested to have the painful tooth extracted. The Dentist ordered [MEDICATION NAME] 5/325, (12 tablets) 1 tablet every 4 hours as needed for pain. The [MEDICATION NAME] order was never added to the Resident MAR and record review revealed there is no indication the Physician was notified of the [MEDICATION NAME] recommendation.

During a review of the clinical record on 12/6/16, there was no indication that a follow up consultation was obtained regarding the tooth extraction.

Further record review on 12/6/16 indicated that there was no formal assessment to identify pain severity and continual monitoring. The Pain Presence Monitor in the Resident’s 11/2016 treatment sheets indicates:

  • Pain present on 11/9/16, 11/11/16, 11/12/16,11/13/16, 11/14/16, 11/15/16, 11/16/16,
    11/17/16, 11/18/16 11/20/16, 11/21/16.
  • No pain presence on 11/10/16 or 11/22/16.
  • No evidence of documentation on 11/19/16 and 11/23/16.

The Pain Presence Scale does not specify time of day or location of pain presence that the Resident had. There was no Pain Presence Monitor form available for 12/2016 in Resident #12’s medical record.

Review of the 11/2016 MAR indicated that the resident received medication on the following five dates:

  • [MEDICATION NAME] HCL IR 5 mg tablet on 11/4/16 and 11/15/16 for severe toothache with positive effect.
  • [MEDICATION NAME] 600 mg as needed. for tooth ache on 11/17/16, 11/18/16 with positive effect, and on 11/19/16 with some effect.

Review of the 12/2016 MAR indicated that on 12/6/16, the resident received both [MEDICATION NAME] 325 milligrams and [MEDICATION NAME] 600 mg for complaints of a tooth ache both with positive effect.

Review of the clinical record on 12/6/16 indicated that the last visit with the Nurse Practioner was 11/18/16, and that the pain involved the whole left side of the patient’s face. No further documentation was in the resident record after 11/18/16 regarding tooth pain or follow up from the Nurse Practitioner.

In an interview on 12/6/16 at 11:30 A.M., the unit secretary, she said the resident has an appointment for a tooth extraction on 12/15/16 which is not documented in the medical record.

In an interview with Resident #12, on 12/7/16 at 9:10 A.M., the resident was crying due to increased pain. The Resident told the surveyor that the pain is so bad that he/she can’t sleep and could not understand why he/she had to wait until 12/15/16 for the tooth to come out. He/she said that the tooth just needs to come out.

In an interview on 12/7/16 at 9:30 A.M., the Director of Social Services (DSS) revealed that she did not know when the follow up appointment was for the tooth extraction. Subsequent to the surveyor’s inquiry of resident’s increased pain presence, the DSS contacted the Dentist and had the appointment changed from 12/15/16 to 12/8/16. At 1:05 P.M., in an interview with Resident #12, the resident revealed that he/she was very happy that the appointment was changed to 12/8/16 and the pain will hopefully subside after the extraction.

3. Resident #6 was admitted to the facility in 9/2016 with the following Diagnosis: [REDACTED].

An admission minimum data set (MDS) completed on 9/19/16 indicated the resident’s cognition was mostly intact. The resident requires supervision for toilet use and a one person physical assist for bathing and hygiene.

The initial nurse’s note, dated 9/16/16, indicated that the facility knew that the resident had a draining cyst and the Resident refused to have it treated. On 12/7/16, review of all of the Resident’s progress notes indicated that the resident refused to have staff observe and or treat his/her open area sacral cyst that was draining. There was an indication in the progress notes that the Resident did allow some nurses to look at it but not change the bandage.

On 12/2/16 at 11:00 A.M., the Surveyor interviewed Resident #6 while in his/her bedroom. The Resident was friendly and engaged in conversation. The Resident’s room was cluttered of his/her own choosing. There was no additional chair to sit on so the Resident offered the Surveyor the bed to sit on. It was then when the Surveyor noticed the sheets that the Resident was sitting on had visible stains of red blood and yellow drainage. When the Surveyor asked the Resident what that was he/she said that they had had a cyst on the buttocks area that was leaking. The Resident was quite proud to say how the bandage gets changed. He/she said that the nurses do not do it, but the Resident does by putting an a dry pad on the inside to his/her jeans and pulls up the pants hoping the bandage holds to the area. The Resident did ask the Surveyor if she wanted to look at the wound. The Resident all of a sudden jumped up off the bed saying that he/she would be right back after a cigarette break. The Resident had his hand on the dirty linen, did not wash his/her hands and walked out of the room.

On 12/7/16 at 2:10 P.M., The Surveyor spoke to the Director of Nurses (DON) about Resident #6’s cyst and the potential for spread for [MEDICAL CONDITION]. She said that it is a blood to blood contact. There was discussion of the possibility of the pathogens living on a surface for 30 days which would need to be looked. The Surveyor had observed the Resident not wash his/her hands after touching the sheets on 12/2/16 abovementioned and later learned that the Resident was changing his/her sheets every day. The DON said that the Resident and staff were in-serviced on infection control as well as the Resident. However, it was apparent that the Resident was not following the in-servicing as he/she was observed to have walked out of the room without washing his/her hands. The Surveyor discussed with the DON if the facility had plans if proper handwashing was not happening. The Resident also had a roommate. The Surveyor asked the DON if the Resident’s Medical Doctor knew about the situation and she said that she thought so but there were no notations in the charts or his notes.

The Surveyor contacted the Medical doctor by phone on 12/3/16 at 10:00 A.M. The Doctor said that he thought that he had heard something about it but had not been actively involved because the Resident was of sound mind and didn’t want the buttock area looked at. He said that the resident is making bad judgements and that he and the facility was going back and forth about the situation. He said that he and the facility had to do a better job at communicating.

The Surveyor spoke with the Nurse Practioner (NP) that come in to see Resident #7 for the first time subsequent to the survey inquiry. The NP said that the Resident did let her see his wound during the first visit. At this time, the practitioner ordered the area to be seen daily and allow the nurses to cleanse the area and the Resident agreed to the plan.

Failed to provide routine and 24-hour emergency dental care for each resident.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and interview, the facility failed to obtain timely dental services for one Resident, (Resident #12), in a total sample of 15 residents. Resident #12 was admitted to the facility in 8/2016, with [DIAGNOSES REDACTED].

Findings include:

On 12/6/16, review of Resident #12’s clinical record indicated that the resident was complaining of increased tooth pain as of 11/7/16 and had last been seen by the dentist on 11/15/16. The Dentist’s note indicated that the resident requested to have the painful tooth extracted. The Dentist ordered [MEDICATION NAME] 5/325, (12 tablets) 1 tablet every 4 hours as needed for pain. Further review of the November medication administration record indicates that the [MEDICATION NAME] order was never added to the Resident MAR and there is no indication the physician was notified of the [MEDICATION NAME] recommendation.

During a review of the clinical record on 12/6/16, there was no indication that a follow up consultation was obtained regarding the tooth extraction. In an interview on 12/6/16 at 11:30 A.M., the unit secretary said that the resident has an appointment for a tooth extraction on 12/15/16 which is was not documented in the Resident’s medical record.

In an interview with Resident #12, on 12/7/16 at 9:10 A.M., the resident was crying due to increased pain. The Resident told the surveyor that the pain is so bad that he/she can’t sleep and could not understand why he/she had to wait until 12/15/16 for the tooth to come out. He/she said that the tooth just needs to come out. In an interview on 12/7/16 at 9:30 A.M., the Director of Social Services (DSS) revealed that she did not know when the follow up appointment was for the tooth extraction. Subsequent to the surveyor’s inquiry of resident’s increased pain presence, the DSS contacted the dentist office and had the appointment changed from 12/15/16 to 12/8/16.

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 record review, observations and interviews, the Facility failed to maintain an Infection Control Program designed to prevent potential transmission of disease and infection for one resident #6 who had an draining cyst.

Findings include:

Resident #6 was admitted to the facility in 9/2016 with the following Diagnosis: [REDACTED].

An Admission Minimum Data Set (MDS) completed on 9/19/16, indicated Resident #4’s cognition was mostly intact. The Resident requires supervision for toilet use and a one person physical assist for bathing and hygiene.

The initial nurse’s note, dated 9/16/16, indicated that the facility knew that the resident had a draining cyst and the Resident refused to have it treated. On 12/7/16, review of all of the Resident’s progress notes by the Surveyor indicated that the resident refused to have staff observe and or treat his/her open area sacral cyst that was draining. There was an indication in the progress notes that the Resident did allow some nurses to look at it but not change the bandage.

Most nurses notes stated, on a daily basis, that despite the Resident having this abscess on his coccyx and buttocks, he/she would not allow the staff to treat. Review of the Facility Policy titled, Infection Control Polices and Procedures, dated 10/01/13 and reviewed 10/31/16, indicated that standard precautions should be used when giving direct care, when:

  • Giving direct care.
  • When there is a potential for exposure to infected/colonized material. As long as the source/site of infection/colonization can be contained.

During a conversation on 12/1/16 with Resident #4 at 10:30 A.M., the Surveyor asked the Resident how he/she was washing and changing the abscess on his coccyx and buttocks. He said that he would estimate the area and put a dry dressing in the area where his jeans were touching the skin and stick it to the jeans. He/she said that sometimes it falls off. The Surveyor noticed that the Resident was sitting on top of his/her sheet that had some pooling blood as well as dry blood along with dry mucus. The Resident said that he/she made his/her bed every day. During the conversation the Surveyor asked if the Resident would wash his/her hands and he/she said that there was not enough time to do that as the smoke break was beginning. The Surveyor also observed the Resident in the elevator that day around 3:00 P.M., (touching the controls) and then going over to the nurses station and touching the top of the nurses station.

On 12/2/16 at 10:35 A.M., The Surveyor spoke with the Nurse Practitioner, who said that she had just started yesterday. She told the Surveyor that the Resident wanted more pain medication so she did see him and was able to evaluate the wound. There was a note written on 12/2/16 to change and cleanse the area with normal saline.

After discussion with the Director of Nurses (DON) on 12/2/16 at 11:30 A.M., she said that the Resident and staff were in-serviced on infection control and apparently that the Resident forgot the in-servicing as he/she walked out of the room without washing his/her hands. When the Surveror asked the DON where the documents about the in-serving was, she said that she had not written it down.

On 12/7/16 at 8:10 A.M., the Surveyor spoke to the Resident’s Medical Doctor (MD) who said that he was familiar with the patient and that although competent, he was making bad decisions. The MD said that he and the staff have been going back and forth about this matter and thought about psych and pain. There was no mention of infection control. The MD said that both he and the facility should do a better job at communication.

Failed to make sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Based on observation, documentation review and interviews, the Facility failed to maintain an effective pest control program to ensure the resident environment is free of pests.

Findings include:

On 12/01/16 at 8:40 A.M., the Surveyor observed several fruit flies flying around the juice machine. Fruit flies were also observed stuck to the kitchen wall nearby. The Surveyor interviewed the Cook at that time and he said fruit flies have been an issue for a while. He said he believed the fruit flies were a result of the night shift either not cleaning the nozzles of the juice machine or not cleaning the nozzles properly. He said it was their responsibility to do so every evening.

An interview was then held with the Food Service Supervisor (F.S.S.). He also said it was the evening shift’s responsibility to clean the nozzles every night and he was unaware they were not doing so.

On 12/01/16 at 8:50 A.M., the Dish Room was observed with the F.S.S. present. A fruit fly was observed flying around the room at that time. In addition, the lid to the heavy duty trash barrel was observed sitting under the dish machine. An interview was then held with the dishwasher with the F.S.S. present. He said he has not used the lid to the trash barrel for a long time. He said he removed it a while ago because it was too heavy for him to keep lifting it up and placing it back down on the barrel. A fruit fly was then observed flying around the trash can. The F.S.S said he was unaware the trash barrel lid had been removed and was not being operated properly. The F.S.S. also said that fruit flies have been an issue since 11/2016 and that the exterminator had been called in more frequently.

On 12/01/16 at 12:25 P.M., the third floor Kitchenette was observed. A dirty breakfast tray was observed on the counter top. Seven 1/2 slices of toast were resting on an uncovered dish and fruit flies were observed either on the toast or flying around them. A small uncovered bowl of milk and cereal was also on the counter top and a fruit fly was observed flying around it. Fruit flies were also observed flying around a nearby trash barrel without a lid on it. Food residue was observed inside the trash barrel.

On 12/01/16 at 12:30 P.M., the F.S.S. and the Corporate F.S.S. entered the area. The Surveyor informed them of the above observations. The F.S.S. said that nursing staff was supposed to call down to the kitchen to have the breakfast tray removed and they did not. He was unaware it had been sitting on the counter top since the morning.

On 12/01/16 at 12:40, the F.S.S. and the Corporate F.S.S. accompanied the Surveyor to the second floor kitchenette. A fruit fly was observed flying around the counter top. The counter top had dried on unknown liquid substances on it. The trash barrel nearby contained trash inside and there was no lid on it.

On 12/01/16 at 4:00 P.M., the Corporate F.S.S. spoke to the Surveyor and said that the facility has hired a new Pest Control company to address the fruit fly issue. On 12/06/16 at 9:10 A.M., a fruit fly was observed flying around the third floor Kitchenette.

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 records reviewed and interviews for 1 of 3 sampled residents (Resident #1), the Facility failed to notify Resident #1’s Physician when Resident #1’s medications related to his/her [MEDICAL CONDITION] disorder and his/her medication to reduce the risk of developing a blood clot were unavailable, and failed to obtain Physician orders [REDACTED].

Findings include:

Pursuant to Massachusetts General Law (M.G.L.), chapter 112, individuals are given the designation of Registered Nurse and Practical Nurse which includes the responsibility to provide nursing care. Pursuant to the Code of Massachusetts Regulation (CMR) 244, Rules and Regulations 3.02 and 3.04 define the responsibilities and functions of a Registered Nurse and Practical Nurse respectively. The regulations stipulate that both the Registered Nurse and Practical Nurse bear full responsibility for systematically assessing health status and recording the related health data. They also stipulate that both the Registered Nurse and Practical Nurse incorporate into the plan of care, and implement prescribed medical regimens. The Rules and Regulations 9.03 define Standards of Conduct for Nurses where it is stipulated that a nurse licensed by the Board shall engage in the practice of nursing in accordance with accepted standards of practice.

The Policy, titled Medication Administration: General, dated 5/15/17, indicated that practice standards were that a Physician or Advance Practice Nurse was to be notified if a medication was not available.

The Hospital Discharge Summary, dated 3/10/17, indicated that Resident #1 medical [DIAGNOSES REDACTED].

The Medication Administration Record [REDACTED].M.; [MEDICATION NAME] (anticoagulant) 70 milligrams (mg) via subcutaneous injection (sc) (injected between the skin and muscle) and Levetiracetam (prevents [MEDICAL CONDITION]) 750 mg 2 tablets by mouth, however the MAR indicated [REDACTED]. There was no documentation that indicated that Resident #1’s Physician had been notified that his/her medications were not administered as ordered or that further instructions were obtained from Resident #1’s Physician.

The MAR, dated 3/11/17, indicated that Resident #1 did not receive the following medications due to be administered at 8:00 A.M.; [MEDICATION NAME] 70 mg sc, [MEDICATION NAME] (treats constipation) 17 grams (gm) by mouth, Alphalipoic Acid (a supplement that aids in energy metabolism beneficial for diabetics) 100 mg by mouth, and Levetiracetam 750 mg 2 tablets by mouth. There was no documentation to indicate that Resident #1’s Physician was notified that he/she had not received the medications or that further instructions were obtained from Resident #1’s Physician.

The Surveyor interviewed Family Member #1 at 11:11 A.M. on 6/21/17. Family Member #1 said when Resident #1 was admitted to the Facility, he/she was not administered all of the medications ordered by his/her Physician because the Facility did not receive the medications from the Pharmacy.

The Surveyor interviewed Nurse #1 at 3:30 P.M. on 6/21/17. Nurse #1 said she was unable to administer all Resident #1’s medications because they had not arrived from the pharmacy during her shift. Nurse #1 said she did not to call to notify Resident #1’s Physician that she did not administer all of Resident #1’s medications.

The Surveyor Interviewed Nurse #4 at 4:15 P.M. on 6/26/17. Nurse #4 said she could not administer all of Resident #1’s medications because they had not arrived from the Pharmacy. Nurse #4 said she did not call Resident #1’s Physician to notify or question if he wanted to provide alternate MEDICATION ORDERS FOR [REDACTED]

The Surveyor interviewed the Director of Nursing (DON) at 2:30 P.M. on 6/21/16. The DON said if Resident #1’s medications were not available, nurses should have notified Resident #1’s Physician that the medications could not be administered to ask if they can hold the medications or obtain alternate orders from the Physician.

Chelsea Skilled Nursing and Rehabilitation, 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.


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Page Last Updated: November 18, 2017