Royal Norwell Nursing & Rehabilitation Center LLC

ROYAL NORWELL NURSING REHAB Norwell MA Elder Abuse Lawyers

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ROYAL NORWELL NURSING REHAB Norwell MA Elder Abuse LawyersAbout Royal Norwell Nursing & Rehabilitation Center LLC

Royal Norwell Nursing & Rehabilitation Center LLC is a for profit, 86 bed Medicare/Medicaid certified skilled nursing facility that provides services to the residents of Norwell, Hanover, Hingham, Duxbury, Scituate, Pembroke, Hanson, Weymouth, Hull, Holbrook, Abington, Braintree, Marshfield, Whitman, and Kingston, as well as other surrounding towns in and near Plymouth County, Massachusetts.

Royal Norwell Nursing & Rehabilitation Center LLC focuses on 24 hour care, respite care, hospice care and rehabilitation services.

Royal Norwell Nursing & Rehabilitation Center LLC
329 Washington Street
Norwell, MA  02601

Phone: (781) 659-4091

Royal Health Group Website

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, Royal Norwell Nursing & Rehabilitation Center LLC in Norwell Massachusetts received a rating of 2 out of 5 stars (a below average rating.)

Performance Area Rating
Overall Rating 2 out of 5 (Below Average)
State Health Inspections 1 out of 5 (Much Below Average)
Staffing 4 out of 5 (Above Average)
Quality Measures 5 out of 5 (Much Above Average)

Fines Against Royal Norwell Nursing & Rehabilitation Center LLC

The Federal Government fined Royal Norwell Nursing & Rehabilitation Center LLC for health and safety violations during the past three years as follows:

  • $2,500 on 07/01/2014
  • $38,113 on 07/19/2016
  • $7,550 on 03/09/2017
  • $19,105 on 09/13/2017

Fines and Penalties

Our Nursing Home Accident and Injury Lawyers inspected government records and discovered Royal Norwell Nursing & Rehabilitation Center LLC committed the following offenses:

The nursing home failed to make sure services provided by the nursing facility meet professional standards of
quality.

Based on record review, staff interview and observation, the Facility failed to follow professional standards of quality for medication administration for 3 (#5, #7, #8) of 15 sampled Residents.

Findings include:

1. For Resident #7, the Facility failed to rotate the injection sites of the scheduled [MEDICATION NAME] and failed to administer sliding scale insulin coverage per the plan of care. Resident #7 was admitted to the Facility in 5/2016 for rehabilitation with [DIAGNOSES REDACTED]. According to the NURSING 2016 Drug Handbook for [MEDICATION NAME]: rotate injection sites within the same region (abdomen, thigh or deltoid) from one injection to the next. Review of the clinical record indicated that on 7/4/16 the physician ordered [MEDICATION NAME] 100 units/milliliter (ml) 10 units to be administered twice daily, subcutaneously.

Review of the Medication Administration Record (MAR) from 7/4/16 to 7/13/16 indicated that [MEDICATION NAME] was administered twice daily, but the injection site was not documented. A medication administration observation for Resident #7 was completed on 7/13/16 at 8:30 A.M During this observation, Medication Nurse (#2) was observed asking the Resident which arm he/she would prefer the insulin administered. The Resident replied it doesn’t matter you pick. Nurse #2 then administered [MEDICATION NAME] 10 units in the Resident’s right arm. After exiting the room, Nurse #2 was asked how he tracks rotation sites for the twice daily scheduled insulin and said he could not explain.

The Surveyor and Nurse #2 then reviewed the electronic MAR and there was no evidence of any injection site documentation for any of scheduled insulin administered since 7/4/16. Nurse #2 said that he would add a prompt to the electronic MAR so that the nurses could ensure that the insulin injection sites were rotated as required. b. The facility failed to administer sliding scale insulin coverage timely per the plan for care.

According to the NURSING 2016 Drug Handbook, [MEDICATION NAME]: inject subcutaneously injection should be followed by a meal within 30 minutes of administration. On 7/4/16 the physician gave new orders to begin sliding scale insulin coverage using [MEDICATION NAME] R insulin 100 units/ml based on blood glucose levels to be completed before meals and at bedtime (8:00 A.M., 12:00 P. M., 4:00 P.M, 8:00 P.M.) Review of the MAR from 7/4/16 through 7/12/16 indicated that the [MEDICATION NAME]coverage was administered late on the following dates: 7/4/16, 7/5/16, 7/6/16, 7/7/16 (at 4:00 P.M and 8:00 P.M), 7/8/16 (at 12:00 P.M. and 4:00 P.M) and 7/10/16.

Further review of the MAR indicated using 7/8/16 as an example, the Resident had a blood glucose level of 193 mg/dl and was administered 2 units of insulin late at 2:24 P.M. Review of MAR indicated the Late Administration: Charted late, Comment: On time. Unit Manager (UM) #1 was interviewed by the Surveyor on 7/12/16 at 4:30 P.M. regarding the documentation in the MAR that frequently reflected Late administration: charted late Comment: given on time. The UM said that she could not explain and referred the Surveyor to the Director of Nurses.

2. For Resident #8, the facility failed to rotate the injection sites of the anticoagulant medication [MEDICATION NAME]. Resident #8 was admitted to the facility April 2016 with [DIAGNOSES REDACTED]. According to the NURSING 2016 Drug Handbook regarding [MEDICATION NAME]: with the patient lying down give by deep subcutaneous injection, alternating doses between the left and right abdominal walls. Review of the clinical record indicated that the resident had admission orders [REDACTED]. Review of the May 2016 electronic MAR indicated that the medication nurses failed to indicate the rotation of the [MEDICATION NAME] injection sites for 31 of 31 days as required. Unit Manager (UM) #3 was interviewed on 7/18/16 at 11:00 A.M. and reviewed the clinical record and MAR with the surveyor. UM #3 said that the Resident received [MEDICATION NAME] twice daily from 4/23/16 to 7/8/16. UM #3 said that the [MEDICATION NAME] rotation sites were not identified. b. The facility failed to ensure that there were physician orders [REDACTED].

Review of the 5/5/16 Urologist report indicated that the Resident reported he/she was doing fine until a month ago when he/she developed shingles that affected ambulation. The Urologist indicated that [MEDICAL CONDITION] developed in the context of shingles associated with constipation. Both are better now. Patient so far is unable to void (following catheter removal) but PVR (post void residual measured by a bladder scan machine) only 237 cc’s (cubic centimeters) and the patient is comfortable. I will recommend waiting till the bladder is fuller before we replace the catheter, Will give another 4 to 6 hours to try and spontaneous voiding. I will see him/her again if the catheter needs to be replaced.

The Urologist recommendations included: Replace Foley only if unable to void associated with pain or if PVR is larger than 500 cc’s. On 5/6/16 the day shift nurse reported that the Resident’s catheter was discontinued the previous day and that the Resident did not void overnight. The nurse indicated that fluids were encouraged with poor effect. The Nurse completed a straight catheterization (without a physician order) and obtained 400 cc of hematuria (bloody urine).

The Resident was not assessed with [REDACTED]. There was no documented explanation why the nurse staff completed a straight catheterization of the Resident in the absence of pain or a bladder scan for PVR’s of greater than 500 cc’s (as ordered).

On 5/7/16 the day shift nurse indicated that the resident had very poor fluid intake and that the Resident had not voided. The nurse indicated that there was no abdomen distention or pain. Per the treatment administration record (TAR) The nurse indicated that she attempted to straight catheterize (without an order) many times and the resident refused. Please refer to F315 3. For Resident #5, the facility failed to ensure that the Resident’s Capillary Blood Glucose (CBG) was checked timely four times a day and failed to administer scheduled Insulin and an oral diabetic medication as ordered. The clinical record was reviewed on 7/12/16 and 7/14/16. Resident #5 was admitted to the facility in 5/2016 with [DIAGNOSES REDACTED].

The Resident also received a diabetic medication by mouth. a. The facility failed to administer insulin and [MEDICATION NAME] (oral antidiabetic) timely per the plan for care. Resident #5 had a physician’s orders [REDACTED]. (On 6/3/16 the same insulin dose, same time, to be administered via an insulin pen.) On 6/16/16, the physician ordered to increase the Humalog 75/25 insulin to 34 units to be administered before breakfast via the insulin pen. On 6/28/16 the Humalog 75/25 was increased again to 36 units.

All orders included to rotate the sites of administration.

Review of the 6/1/16 through 7/13/16 MARs indicated that the Resident was administered morning insulin late on 6/1/16, 6/2/16, 6/3/16, 6/5/16, 6/6/16, 6/7/16, 6/11/16, 6/13/16, 6/18/16, 6/19/16, 6/22/16, 6/27/16, 6/29/16, 7/2/16, 7/3/16, 7/4/16, 7/6/16, 7/10/16 (a total of 18 times). In addition, from 6/3/16-7/13/16, there was no injection sites documented as required. Resident #5 also had an order dated 5/26/16 for Humalog Mix 75/25 suspension, 24 units subcutaneous to be administered before dinner and to rotate sites of administration.

Review of the 6/16 thru 7/13/16 MARs indicated that the Resident was administered 5:00 P.M. dose of insulin late on 6/2/16, 6/4/16, 6/7/16, 6/9/16, 6/10/16, 6/13/16, 6/17/16, 6/20/16, 6/23/16, 6/27/16, 7/3/16, 7/5/16, 7/6/16, 7/8/16 (a total of 14 times.) The Resident also had a physician’s orders [REDACTED].M. and 5:00 P.M

Review of the 6/16 thru 7/13/16 MAR indicated that the Resident was administered the 8:00 A.M. [MEDICATION NAME] late on 6/1/16, 6/2/16, 6/3/16, 6/4/16, 6/6/16, 6/7/16, 6/11/16, 6/13/16, 6/17/16, 6/18/16, 6/19/16, 6/22/16,6/27/16, 6/29/16, 7/2/16, 7/3/16, 7/4/16, 7/6/16, 7/10/16 and 7/11/16, for a total of 20 times.

The 5:00 P.M. [MEDICATION NAME] was administered late on 6/4/16, 6/10/16, 6/13/16, 6/17/16, 6/20/16, 6/23/16, 6/27/16, 7/3/16, 7/5/16, and 7/6/16, for a total of 10 times.

b. The facility failed to check the Resident’s Capillary Blood Glucose (CBG) timely as ordered by the physician. Resident #5 had a physician’s orders [REDACTED].M., 12:00 P.M., 4:00 P.M. and 8:00 P.M.) Review of the 6/16 MAR indicated the following: – Review of the 8:00 A.M. CBG’s indicated that the facility was late 13 times in 30 days. For example, on 6/13/16, the 8:00 A.M. CBG was documented as checked at 11:53 A.M. -Review of the 12:00 P.M. CBG’s indicated the facility was late 10 times in 30 days. For example, on 6/13/16 the CBG was documented as checked at 3:53 P.M. -Review of the 4:00 P.M. CBG’s indicated that the facility was late 16 times in 30 days. For example, on 6/10/16 the CBG was documented as checked at 8:22 P.M. – Review of the 8:00 P.M. CBG’s indicated that the facility was late 5 times in 30 days. For example, on 6/30/16 the CBG was documented as checked at 11:54 P.M. Review of the 7/16 MAR (7/1-7/13/16) indicated the following: – Review of the 8:00 A.M. CBG’s indicated that the facility was late 4 times in 13 days.

Review of the 12:00 P.M. CBG’s indicated the facility was late 3 times in 13 days.

Review of the 4:00 P.M. CBG’s indicated that the facility was late 4 times in 13 days.

Review of the the 8:00 P.M. CBG’s indicated that the facility was late 4 times in 13 days.

The nursing home failed to provide residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores.

Based on record review, staff interview and observation the facility failed to provide timely treatment and effective interventions for a Resident that developed an avoidable pressure wound for 1 (#12) of 3 sampled Residents with pressure sores, from a total sample of 15 Residents.

Findings include:

Resident #12 was admitted to the facility in 8/2015 with [DIAGNOSES REDACTED]. Review of the quarterly Minimum Data Set (MDS) signed as completed on 4/11/16, indicated that the Resident had BIMS score of 15 of 15 indicating that the Resident was cognitively intact, required extensive assistance for bed mobility and transfer with assist of two people, had limited range of motion in lower extremities and used a wheel chair for mobility. The MDS also identified that the Resident was at risk for developing a pressure area and had a pressure relieving device in the chair and bed.

Review of the Norton Plus Skin Risk Assessment, dated 4/6/16, indicated that the Resident was at moderate risk for developing a pressure area with a score of 11.

Review of the nurse’s note dated 4/14/16 at 9:09 A.M., indicated that the Resident received new bilateral KAFO (Knee ankle foot orthotic) braces to replace the previous orthotic’s that were not working properly. The Resident had received Physical Therapy (PT) services starting 4/21/16 and was discharged from service on 5/20/16. The PT documented that the Resident was recently fitted for a Bilateral KAFO braces and was tolerating wearing the braces for 8 hours a day without redness, swelling or discomfort. There was no documented evidence that staff were trained about the plan to don/doff the braces in order to ensure carry over of services.

The nurse documented on 5/31/16 at 4:29 P.M. that the Resident was transferred to the South unit. On 5/31/16 at 11:50 P.M. Unit Manager (UM) #2 documented that the Resident had developed a circular area to the side of the left thigh with a beefy red center with pale yellow slough, edges dark, drainage sero sang, no odor. No wound measurements were recorded at this time. The MD was notified and a new order for a treatment was obtained. The MD also requested that the wound physician be contacted. A new care plan was developed on 5/31/16 identifying a new Stage II pressure ulcer located on the left back thigh. The approaches (interventions) included: -turn and reposition with device at least every two hours as tolerated by Resident

-keep clean and dry -treat as ordered -notify MD if treatment ineffective -report signs and symptoms of infection -dietary to assess protein, calories, vitamins and mineral supplements -air mattress in place -bilateral braces as ordered

-wound MD consult and PT eval as needed. No other assessment of the Resident’s pressure ulcer status was completed until 6/8/16 when the Unit Manager (UM) #2 completed a Body Check Observation Report (weekly skin assessment).

The UM indicated that the Resident’s skin was warm, dry, normal color, normal skin turgor with a left thigh abrasion (not a pressure ulcer as previously assessed), with no drainage or signs and symptoms of infection. On 6/10/16 the Wound physician evaluated and identified that Resident #12 had a stage II pressure wound measuring 1.5 X 13 X 0.1 cm (centimeters) to the left posterior thigh. The physician also documented that the area had macerated tissue (due to excess moisture) and moderate serous drainage.

The physician documented that he spoke with nursing and PT staff to evaluate the pressure applied by the KAFO brace and the need for foam padding. There was no documented evidence that foam padding was previously considered by facility staff. On 6/22/16 UM #2 completed a weekly skin assessment and again indicated that the back of left thigh area was healing, with no drainage or signs and symptoms of infection. On 6/24/16 the Wound physician saw the Resident again and identified that there was no change to the pressure wound and to continue the treatment. On 6/29/16 the Unit Manager completed a weekly skin assessment and documented no change in assessment. The UM provided no measurements of the Resident’s wound (the UM indicated in interview on 7/13/16 at 1:00 P.M. that she completes measurements of the wounds on a weekly basis).

The Resident was not seen by the Wound physician on 7/1/16. On 7/6/16 the Unit Manager documented on the weekly skin assessment for Resident #12 that the left thigh was scabbed over, no drainage or signs or symptoms of infection. (There were no additional assessments of the wound between 6/29/16 and 7/6/16.) On 7/8/16 the Wound physician documented that the Resident’s wound was now documented as a Stage III wound measuring 2 X 2 X 0.3 cm with moderate serous drainage which required debridement and a change in the wound care treatment orders to add the [MEDICATION NAME] agent Santyl daily.

The physician recommended that the physical therapist evaluate the brace for padding (this is the second time the physician recommended paddding to the brace) to relieve undue pressure as the Resident gets out of bed and then sits most of the day. On 7/11/16 the Physical Therapy Aide (PTA), not a licensed PT, assessed the Resident’s brace and documented that the Resident agreed with the plan to adjust padding on left brace secondary to skin complications (a stage III pressure wound). There was no indication who was responsible for adjusting the padding and no documented evidence that training was provided to staff. Review of the Nurse’s notes on 7/11/16 failed to identify any of the recommendations made by the PTA. During unit tour on 7/12/16 at 8:30 A.M. UM #2 identified that Resident #12 had a stage I (and not a stage III as previously identified) on the left back thigh secondary to pressure from the leg brace and was being seen by the Wound physician.

The Unit Manager said that the Resident did not always like to remove the brace while sitting in the wheel chair. On 7/12/16 at 11:20 A.M., the day shift nurse documented that the Resident was seen by the PT who recommended for the Resident to only wear bilateral braces during transfer and ambulation and to remove them (to relieve pressure) while in bed or in the wheel chair. On 7/15/16 at 9:50 A.M. the PT was interviewed and said that when the Resident had worn the brace 24 hours a day it produced pressure on the thigh and since the brace is off, except when transferring, the area is improving. On 7/15/16 at 3:00 P.M. the Wound physician was interviewed and said that the wound had developed due to pressure on the thigh from the brace. The Physician said that he recommended padding/foam with no result from recommendations made on 6/10/16.

The physician stated that he made a second recommendation for padding on 7/8/16 and the padding was adjusted sometime after that. The physician said that the Resident agreed to remove the brace while in bed or in the wheel chair. The physician said that the area looked better that day.

The nursing home failed to make sure that each resident who enters the nursing home without a catheter is not given a catheter, and receive proper services to prevent urinary tract infections and restore normal bladder function.

Based on record review and interviews, the facility failed to ensure for 1 Resident (#8) in a total sample of 15, that the Resident received appropriate treatment and services to restore as much bladder function as possible.

Findings include:

For Resident #8, the facility failed to follow the Urologist’s recommendations, a straight catheter was reinserted, and the Resident developed a urinary tract infection. Resident #8 was admitted to the facility 4/2016 with [DIAGNOSES REDACTED]. The initial Minimum Data Set (MDS) assessment with a reference date of 4/23/16, indicated that the Resident was cognitively impaired and was dependent on facility staff for most activities of daily living and had a catheter.

Review of the 4/19/16 hospital discharge summary indicated that the resident had a Foley catheter in place because he/she had failed a voiding trial twice. The summary indicated a repeat voiding trial can be tried in a week or so, especially if his/her mobility improves. Review of the clinical record indicated that on 4/25/16 the evening shift nurse indicated that the Resident was visited by the physician who wanted the Resident seen by the Urologist, as soon as possible, due to the failed voiding trials at the hospital.

On 4/26/16 the day shift nurse’s note indicated that the Urology appointment was scheduled for 5/5/16. Review of the 5/5/16 night shift nurse’s note indicated that the Resident’s Foley catheter was removed at 5:00 A.M. as ordered prior to the Urology appointment scheduled at 12:10 P.M. that day. Review of the 5/5/16 Urologist report indicated that the Resident reported he/she was doing fine until a month ago when he/she developed shingles that affected ambulation.

The Urologist indicated that [MEDICAL CONDITION] developed in the context of shingles associated with constipation. Both are better now. Patient so far is unable to void (following catheter removal) but PVR (post void residual measured by a bladder scan machine) only 237 cc’s (cubic centimeters) and the patient is comfortable. I will recommend waiting till the bladder is fuller before we replace the catheter, Will give another 4 to 6 hours to try and spontaneous voiding. I will see him/her again if the catheter needs to be replaced.

The Urologist recommendations included: Replace Foley only if unable to void associated with pain or if PVR is larger than 500 cc’s. On 5/6/16 the day shift nurse reported that the Resident’s catheter was discontinued the previous day and that the Resident did not void overnight. The nurse indicated that fluids were encouraged with poor effect. The Nurse completed a straight catheterization (without a physician order) and obtained 400 cc of hematuria (bloody urine).The Resident was not assessed with [REDACTED]. There was no documented explanation why the nurse staff completed a straight catheterization of the Resident in the absence of pain or a bladder scan for PVR’s of greater than 500 cc’s (as ordered).

On 5/7/16 the day shift nurse indicated that the resident had very poor fluid intake and that the Resident had not voided. The nurse indicated that there was no abdomen distention or pain. Per the treatment administration record (TAR) The nurse indicated that she attempted to straight catheterize (without an order) many times and the resident refused. The physician was called. According to the 5/7/16 evening shift nurse’s note the physician visited (no progress note was available) and was aware of urine retention.

The physician gave new orders to straight catheterize the Resident daily if the urine output is less than 400 cc’s.

Review of the 5/8/16, 5:30 P.M. nurse’s note indicated that the resident had no output since 1:00 P.M. and continues with poor fluid intake. No pain was reported. The nurse indicated that a urine analysis was positive and a urine culture was pending. The nurse also indicated that the physician was called because there were two orders in the chart, one to straight catheterize if less than 400 cc and another to replace the catheter if the resident was unable to void. A covering Nurse Practitioner (NP) returned the call and indicated if the Resident had no urine output for 6 hours to straight catheterize. If urine output greater than 250 cc’s leave the catheter in. On 5/8/16 at 6:50 P.M. the Resident was catheterized with more than 250 cc’s (no exact amount was recorded) and the catheter was left in. Review of the 5/10/16 evening shift Nurse’s note indicated that the physician was called about the urine culture and the physician gave new orders to begin the antibiotic, [MEDICATION NAME] for five days for treatment of [REDACTED].

Unit Manager #3 was interviewed on 7/18/16 at 11:00 A.M. and asked why the Urologist’s recommendations were not followed, The Unit Manager could not explain. UM #3 was asked if a bladder scan was available to measure PVR’s, she said yes it is now but could not explain when the machine was made available for Resident use. On 7/19/16 at approximately 11:00 A.M. the physician was interviewed.

The physician was asked about the Urologist’s 5/5/16 recommendations. The physician said that the recommendations were not implemented as ordered because the facility had no machine (bladder scanner) to record the post void residuals. The physician said that the Resident had been treated for [REDACTED].

The nursing home failed to make sure that residents with reduced range of motion get proper treatment and services to increase range of motion.

Based on observation, record review and staff interview, the facility failed to ensure that 1 (#4) sampled Resident, in a total sample of 15 Residents, received appropriate treatment and services to increase range of motion (ROM) and prevent avoidable contractures.

Resident #4 was admitted to the facility in 6/2015 with [DIAGNOSES REDACTED]. Additional [DIAGNOSES REDACTED].

Review of the 6/23/16 significant change Minimum Data Set (MDS) assessment indicated that the Resident was cognitively impaired and required extensive assistance from facility staff for all activities of daily living (ADL). The Resident was coded as not having contractures. During Medication Administration Observation for Resident #4 on 7/13/16 at 9:10 A.M., the Resident complained to the Medication Nurse #1 that he/she had 10 out of 10 left knee pain and was administered [MEDICATION NAME] (narcotic). Medication Nurse #1 said that the Resident had new complaints of left knee pain for the past couple weeks. At the time of the Medication Administration Observation the Unit Manager and a CNA (who had finished providing care) were observed repositioning the Resident on his/her back in preparation for the medication administration.

The Resident was observed lying on his/her back with the left knee pulled up toward his/her chest. Review of the clinical record and the Medication and Treatment Administration Records (MAR/TAR) on 7/13/16 indicated that Resident #4 was assessed and received pain medication for a new complaint of 10/10 left knee pain with effective relief on 7/6/16, 7/7/16, 7/9/16, 7/10/16, 7/12/16, and 7/13/16. There was no documented assessment in the clinical record that the Resident had any contractures.

On 7/15/16 at 9:50 A.M. the Physical Therapist (PT) and Occupational Therapist (OT) were interviewed. Both Therapists’ said that they began working at the facility in April and have never been asked to screen Resident #4. The PT said that the last time that the Resident was on active case load was in September 2015 and was not observed with contractures.

The Surveyor asked how they (therapy staff) would be made aware if a Resident was developing contractures or other functionality issues. The PT said that they are made aware during Quality of Life Rounds held every Thursday with the Director of Nurses (the Unit Managers do not attend) and Director of Activities or via a nursing request for a rehabilitation screen.

On 7/15/16 at 10:30 A.M., the Resident’s primary CNA #1 was asked about the care that she provided for Resident #4. CNA #1 said that the Resident is totally dependent for care and that she washes and dresses the Resident and drains the urinary catheter at the beginning and end of the shift. CNA #1 said the Resident is transferred out of bed using a mechanical lift and requires positioning. CNA #1 was asked about the Resident’s left knee mobility said that he/she has been complaining of left knee pain and was unable to straighten the knee for weeks. CNA #1 said that the Nurses are aware that the Resident cannot straighten his/her knee. CNA #1 was asked if she provides any ROM exercises for the Resident’s extremities said no. The current CNA care card (which provides care guidance to Certified Nurse Aide staff) was reviewed with CNA #1. The care card failed to identify that Resident #4 had contractures. No range of motion exercises were identified to be completed by the CNA staff. The Surveyor observed CNA #1 provide assistance with care on 7/15/16 at 10:35 A.M.

Resident #4 was observed with the left knee pulled upward toward his/her chest and the right leg flexed at the hip. The Resident was asked by the CNA to straighten the left knee and and attempted to so and was unable. The Resident said that it hurt. The Resident was asked by the Surveyor if staff exercised his/her legs and the Resident said no. On 7/15/16 at approximately 2:30 P.M., the Surveyor observed Resident #4’s wound treatment completed by the Wound physician. During this observation the Resident was observed positioned on his/her side for wound care with the left knee pulled up into the chest.

The physician was asked how long the Resident’s knee was contracted and he said a few weeks. On 7/18/16 at approximately 3:00 P.M., the Director of Nurses (DON) and the Regional Nurse were interviewed and asked about the Resident’s contractures. The DON provided a Care Plan for Mobility (not previously observed in the record) with an initial date of 3/16/16 and last reviewed 6/29/16 that indicated that the Resident had impaired mobility related to contractures on the bilateral lower extremities (BLE). Interventions included:

– PT/OT as ordered (no request for screen per interview with PT)

– Assess/monitor/report: contracture, pain, weakness, immobility, swelling and weight loss (No assessment of the Resident’s BLE contractures identified in the clinical record)

– Assess/monitor/provide wheel chair

– Gentle ROM to BLE with AM care (not completed per interview)

– Hospice CNA to assist with mobility and ROM as necessary (the resident was not on Hospice)

The Surveyor asked the DON when the bilateral contractures developed and said that she would need to check. The DON was unable to explain when the Resident was last screened by therapy.

Findings include:

Resident #4 was admitted to the facility in 6/2015 with [DIAGNOSES REDACTED].

The nursing home failed to make sure that doctors see a resident's plan of care at every visit and make notes about progress and orders in writing.

Based on record review and interviews, the facility failed to ensure for 2 Residents (#2 & #4) of 15 sampled Residents, that the physician was aware of the Resident’s total plan for care including changes in the status of clinical care as required. The facility failed to ensure that the physician provided supervision to the Nurse Practitioner (NP).

Findings include:

1. For Resident #4, the physician failed to visit the Resident in over one year and failed to provide supervision to the Nurse Practitioner to address multiple changes in the Resident’s medical status. Resident #4 was admitted to the facility in 6/2015 with [DIAGNOSES REDACTED]. Additional [DIAGNOSES REDACTED]. Review of the NP notes indicated that on 10/15/15 the Resident was seen for question of Urinary Tract infection and Asthma exacerbation, blood work was ordered and nebulizer and antibiotic medications were initiated. The NP visited again on 11/27/15 (the progress note visit was not made available to the facility until 1/19/16) and made no follow-up assessment of the Resident’s 10/15/15 change in status. There was no assessment or reference to the status of the Resident Stage IV pressure wound.

Review of the NP note of 1/13/16 indicated that the Resident was assessed for anxiety and pain with no new orders. There was no reference to the Resident’s significant weight loss and the Resident being placed on hospice on 1/8/16. The NP visited the facility on 1/19/16 and the progress note visit was not made available to the facility until 2/1/16. Review of the 2/1/16 NP’s visit and physical examination was identical to the 1/19/16 visit with the exception that scripts were given for [MEDICATION NAME] (for anxiety) and Tylenol (for pain).

The Resident was hospitalized from [DATE] through 2/22/16. Per the 2/22/16 discharge summary the Resident was treated for [REDACTED]. The next NP visit, available for review following the February hospitalization , was completed 5/2/16 and not provided to the facility until 6/13/16. The 5/2/16 NP’s visited for complaints of wheezes with monitoring of lung sounds and lab work ordered. There was no comprehensive assessment of Resident’s plan of care and no documented evidence that the Physician had provided the visits as required. Review of monthly physician orders 1/2016 through 6/2016 indicated that the NP initial the orders but did not date them as required.

Unit Manager #2 was interviewed on 7/13/16 at 1:00 P.M. and reviewed existing Physician/NP progress notes with the Surveyor. The UM said that all the progress notes for Resident #4 were accounted for and that the last NP visit was completed 5/2/16. UM #2 said that the Resident was admitted to the hospital in June for a [MEDICAL CONDITION] exacerbation and is currently receiving treatment for [REDACTED]. UM #2 said that she called the physician the previous day to catch up with Resident visits. UM #2 said that she could not explain why there is a delay in obtaining progress notes timely from the NP. The Physician was interviewed by the Surveyors on 7/13/16 at 2:00 P.M. The physician was asked about his last visit being over a year ago and he said that he was busy. The Physician reviewed the NP notes and said he could not explain why the notes were not comprehensive.

2. For Resident #2 the physician failed to ensure that the Resident was visited as required and failed to provide supervision to the Nurse Practitioner (NP) to address to address multiple changes in the Resident’s status. Resident #2 was admitted to the facility in 1/2014 and had active [DIAGNOSES REDACTED]. A review of the clinical record on 7/15/16 indicated that in June 2016 the Resident was seen by the Wound physician on a weekly basis for a lymphedemic wound of the right lateral shin, had increased incontinence and was initialed on the antipsychotic medication [MEDICATION NAME] due to hoarding behaviors. Review of the physician progress notes [REDACTED]. Further review indicated that there was no documented evidence provided during survey that the Resident was visited by either the Physician or NP from 12/29/15 through 6/5/16 when the annual physical examination form was completed by the NP.

Physician orders for March 2016 through June 2016 were initial by the NP but not dated as required. Review of the 6/5/16 NP’s progress note indicated the Resident was stable. On 6/10/16 the NP visited due to a subtherapeutic INR with no overview of the Resident’s status. UM #2 was interviewed on 7/15/16 at 1:00 P.M. and reviewed the existing physician and NP documentation with the Surveyor. UM #2 said that the existing documentation indicated that the Resident was not visited from 12/29/15 through 6/5/16. UM said she could no interpret the physician notes of 12/14/16 and 7/12/16. The Physician was interviewed by the Surveyors on 7/13/16 at 2:00 P.M. and was asked about the legibility of his progress notes and did not respond.

The nursing home failed to safely provide drugs and other similar products available, which are needed every day and in emergencies, by a licensed pharmacist

Based on record review and interview with staff, the facility failed to ensure that routine drugs were administered timely for 7 (#1, #3, #5, #7, #9, #11, #12) of 15 sampled Residents. The facility failed to ensure that emergency medication kits were replaced when opened for three of three units.

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. A. Unit Manager (UM) #1 was interviewed by the Surveyor on 7/12/16 at 4:30 P.M. regarding the documentation in the electronic Medication Administration Record [REDACTED]. During Medication Administration Observation on 7/13/16 at 9:45 A.M., Medication Nurse #1 was asked what would constitute a late medication administration and said that the Nurse has a one hour window on either side of the scheduled medication administration time to administration the medication. When the medication falls outside the window the electronic MAR indicated [REDACTED]. Medication

#1 said that she was instructed to document on time and has been doing so since the MAR indicated [REDACTED]. Unit Manager (UM) #3 was interviewed by the Surveyors on 7/18/16 at 11:00 A.M. was asked why the medication nurses are documenting in the MAR indicated [REDACTED]. UM #3 said that she had recently completed orientation and was instructed by her preceptor to document on time. UM #3 said that her preceptor was UM #2.

The Medical Director was interviewed by the Surveyors via conference call on 7/20/16 at 4:15 P.M. and was asked if he was aware of late administration of medications and he said no.

1. For Resident #1, the facility failed to administer 4 scheduled medications timely as ordered by the physician.

2. For Resident #3, the facility failed to administer 5 scheduled medications timely as ordered by the physician.

3. For Resident #5, the facility failed to administer 3 scheduled medications timely as ordered by the physician.

4. For Resident #7, the facility failed to administer scheduled medications timely as
ordered by the physician.

5. For Resident #9, the facility failed to administer 3 scheduled medications timely as
ordered by the physician.

6. For Resident #11, the facility failed to administer 2 scheduled medications timely as
ordered by the physician.

7. For Resident #12, the facility failed to administer 3 scheduled medications timely as
ordered by the physician.

B. Emergency medication kits.

1. During an inspection of the South Unit’s medication room on 7/18/12 at 12:15 P.M., with Medication Nurse #1, the following was observed:

a. The Antibiotic emergency kit was unlocked on 7/12//16. The entire inventory of the antibiotic’s Nitrofurantoin and Keflex were missing. There was no information that the kit had been reordered from the pharmacy.

b. The Coumadin emergency kit was unlocked. The anticoagulant medication Coumadin was missing. There was no further information to indicate when the kit was opened, when the medication had been removed, or if the kit had been reordered from the pharmacy. Nurse #1 said that the emergency kits should have been re-ordered from the pharmacy when they were opened, and said that the kits would be ordered today.

c. A full blisterpack of the medication Ditropan (bladder relaxant), a partial blisterpack of Coumadin, and a partial blisterpack of Lasix (diuretic), that the Medication Nurse said were actively being used for three different Residents, were observed on the top shelf in the medication cabinet. Nurse #1 said she could not explain why the three blisterpack’s were not in the medication cart as required.

2. During an inspection of the North Unit medication room on 7/18/12 at 12:45 P.M., with Unit Manager (UM) #1, the following was observed: a. Emergency kit #3050 was unlocked. The entire inventory of Kayexalate (used in emergency to reduce excessive Potassium levels) was missing. There was no further information to indicate when the kit was opened, when the medication had been removed, or if the kit had been reordered from the pharmacy. b. The Main emergency drug kit was unlocked. Drawer #1 was unsealed and the medication Sinemet (used to treat Parkinson’s disease), and the cardiac medication Norvasc, was missing. There was no further information to indicate when the kit was opened, when the medication had been removed, or if the kit had been reordered from the pharmacy. c. The Insulin emergency kit was unlocked and the only Novolin insulin inventoried for the kit was missing. There was no further information to indicate when the kit was opened, when the medication had been removed, or if the kit had been reordered from the pharmacy Unit Manager #1 said that the emergency kits should have been re-ordered from the pharmacy when they were opened, and said that the kits would be ordered today.

3. During an inspection of the East Unit medication room on 7/18/12 at 1:00 P.M., with Unit Manager (UM) #3, the following was observed:

a. The Antibiotic kit was observed unlocked. The medication Keflex was missing. There was no further information to indicate when the kit was opened, when the medication had been removed, or if the kit had been reordered from the pharmacy. UM #3 said that the South unit nurse had borrowed it earlier that day but she hadn’t completed the paperwork as required.

b. The Insulin emergency kit was observed unlocked on 6/27/16 and the only Humalog insulin inventoried for the kit was missing. UM #3 said that the kit was reordered from the pharmacy on 7/18/16, not at the time that the kit was opened as required.

The nursing home failed to maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.

Based on observations and staff interview, the facility failed to ensure that insulin medication was dated when opened.

Findings include:

Based on observations and staff interview, the facility failed to ensure that insulin medication was dated when opened.

1. For Resident #3, the facility failed to ensure that the physician’s progress notes were available in the clinical record.

Review of the physician’s progress note section of the medical record indicated there was no documented evidence that the Resident was seen by the physician. The Resident was seen by the Nurse Practitioner on 6/29/15, 8/4/15, 8/11/15, 8/16/15, 8/27/15, 1/13/16, 5/9/16 and 5/31/16.

Interview with the Primary Care physician on 7/13/16 at 2:00 P.M. said that it has been busy and could not explain why he had not written a note in Resident #3’s medical record in over a year.

2. For Resident #8, the facility failed to ensure that the physician’s progress notes and the hospital discharge summary were available in the clinical record.

Resident #8 was admitted to the facility in 4/2016 with [DIAGNOSES REDACTED]. Review of the clinical record on 7/15/16 indicated that the hospital discharge summary, the physician’s admission history and physical and admission progress notes were missing from the record.

The Director of Nurses said on 7/15/16 that staff checked the overflow record and the information was unavailable.

Boston Nursing Home Neglect and Elder Abuse Lawyers

In addition to the above reported findings, the nursing home was also cited for the following deficiencies during the same period in 2016:

  • Try to resolve each resident’s complaints quickly.  Based on record review of Resident Council Minutes and Residents, group and staff interviews, the facility failed to ensure prompt efforts to resolve grievances that the Residents voice at Resident Council Meeting.
  • Allow residents to easily view the results of the nursing home’s most recent survey.  Based on observation, record review and staff interview, the facility failed to ensure
    that Residents have the right to examine the results of the most recent surveys including Life Safety survey results and any deficiencies from subsequent complaint investigations with plans of correction in effect with respect to the facility.
  • Make sure each resident has the right to have a choice over activities, their schedules and health care according to his or her interests, assessment, and plan of care.  Based on record review, Residents and staff interviews and observation, the facility failed to ensure that Residents have the right to choose activities and health care schedules consistent with their plans of care and make choices about aspects of their care in the facility for 2 (#11 & #12) of 15 sampled Residents.
  • Completely assess the resident at least every twelve months.  Based on record review and staff interview, the facility failed to ensure that a comprehensive assessment was conducted not less than every 12 months for 1 (#3) of 15 sampled Residents.
  • Make sure that each resident gets a nutritional and well balanced diet, unless it is not possible to do so.  Based on record review, staff interview and observation, the facility failed to ensure that Residents maintain acceptable parameters of nutritional status, including body weight, for 2 Residents (#8 & #15) of 15 sampled Residents.
  • Use a registered nurse at least 8 hours a day, 7 days a week. Based on record review and staff interview, the facility failed to ensure that a Registered Nurse worked at least 8 consecutive hours a day, 7 days a week.
  • Make sure that the nursing home area is free from accident hazards and risks and provides supervision to prevent avoidable accidents.  Based on record review and staff interview, the facility failed to ensure that Residents received adequate supervision and assistance devices to prevent falls for 1 (#15) of 15 sampled Residents.
  • Have enough nurses to care for every resident in a way that maximizes the resident’s well being. Based on record review, staff interview and observation, the facility failed to ensure that there was sufficient qualified nursing staff, available on a daily basis, to meet Residents’ needs for nursing care in a manner and in an environment which promotes each resident’s physical, mental and psychosocial well-being, thus enhancing their quality of life.
  • Keep accurate, complete and organized clinical records on each resident that meet professional standards.  Based on record review and staff interview, the facility failed to ensure that clinical records were complete, accurately documented, readily accessible and systematically organized for 2 Residents (#3 and #8) of 15 sampled Residents.

Royal Norwell Nursing & Rehabilitation Center LLC, 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.

 

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Norwell Elder Abuse and Nursing Home Neglect Attorneys Serving the South Shore

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: December 29, 2017

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