Grosvenor Park Health Center

MI Elder Abuse Free Legal ConsultationDid someone you love suffer elder abuse or neglect at Grosvenor Park Health Center? 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 Grosvenor Park Health Center

Grosvenor Park Health Center is a for profit, 123-bed Medicare/Medicaid certified skilled nursing facility that provides services to the residents of Peabody, Marblehead, Swampscott, Beverly, Lynn, Danvers,  Saugus, Lynnfield, Middleton, and the other towns in and surrounding Essex County, Massachusetts.

Grosvenor Park Health Center
7 Loring Hills Ave
Salem, MA 01970

Phone: (978) 741-5700
Website: http://grosvenorparkhc.com/

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 2018, Grosvenor Park Health Center in Salem, Massachusetts received a rating of 3 out of 5 stars.

Performance Area Rating
Overall Rating 3 out of 5 (Average)
State Health Inspections 2 out of 5 (Below Average)
Staffing 3 out of 5 (Average)
Quality Measures 5 out of 5 (Much Above Average)

Fines Against Grosvenor Park Health Center

The Federal Government fined Grosvenor Park Health Center $2,300 on March 20th, 2015 and $66,705 on August 27th, 2016 for health and safety violations.

Fines and Penalties

Our Nursing Home Accident Lawyers inspected government records and discovered Grosvenor Park Health Center committed the following offenses:

Failed to develop policies that prevent mistreatment, neglect, or abuse of residents or theft of resident property.

Based on Resident and staff interview, record review and review of the facility policy for Abuse, Neglect and Misappropriation, the facility failed to follow facility policy to investigate and report timely an allegation of misappropriation of residents property for 1 Non-sampled Resident (NS#1).

Findings include:

For NS #1 the facility failed to report and investigate an allegation of misappropriation of Residents property. During the Quality of Life Assessment Group interview, with surveyor on 7/12/17 from 3:00 P.M., through 3:59 P.M., NS #1 said he/she had money stolen from him/her about six weeks ago. NS #1 said that he/she reported the concern about the money to a staff person who was in charge. NS #1 said he/she did not get any follow up information from staff on the allegation of stolen money. On 7/17/17, review of the Department of Public Health’s (DPH) Health Care Facilities Reporting System (HCFRS) (the system for facilities to report allegations of abuse including misappropriation) did not identify any report of misappropriation was made by the facility.

On 7/18/17, review of the facility’s Grievance Registry did not indicate any report made by NS #1 of missing or stolen money. Review of the facility’s Abuse Prohibition: Identification and Reporting Policy, revised 11/26/16, indicated that all alleged violations of abuse, neglect, exploitation or mistreatment, misappropriation of property, and injuries of unknown source that result in serious bodily injury are reported immediately to the administator and to other officials according to state law. Such violations must be reported to the state agency (DPH) immediately upon awareness of the allegation and no longer than two hours after being aware of the allegation.

During interview with the Administrator on 7/20/17 at 3:00 P.M., she said she was unaware of any report from NS #1 about an allegation of stolen money and that she would investigate immediately. On 7/18/17 at 4:30 P.M., the Administrator said the former Director of Nurses was called and had no recall or record of NS #1’s allegation of stolen or missing money. The Administrator said she was reporting the allegation to DPH and the investigation would continue. On 7/24/17 at 7:45 A.M., during an interview with the Administrator, she said that she identified the Nurse to whom NS #1 reported his/her allegation of stolen money. The Administrator said that the Nurse had passed on NS #1’s concern to the Unit Manager, who no longer works at the facility. The administrator expressed concern that two staff members did not report the allegation of stolen money (as required) by NS #1 resulting in a delay in reporting and investigating the alleged misappropriation.

Failed to provide housekeeping and maintenance services.

Based on observation, environmental tours and Resident and staff interviews, the Facility failed to provide adequate housekeeping and maintenance services necessary to maintain an orderly, homelike and comfortable interior in resident rooms and on 2 of 3 resident units.

Findings include:

1. During an environmental tour conducted on 7/24/17 from 10:00 A.M.-10:46 A.M., on the Phillips Unit the following was observed:

-Room 204 A, the vinyl striped chair was torn on the right arm rest.
-Room 204 B side, vinyl striped chair had chipped legs and the vinyl was worn on the right arm rest.
-Room 206, both vinyl striped chairs had chipped and worn legs.
-Room 208 A, the vinyl striped chair had a stain on the seat back, scuffed legs and the vinyl was split on the arms and the seat, the B side, chair had scuffed chair legs and splits of the vinyl on both arms.
-Room 207 A, the vinyl covered striped chair had worn right and left arm rests.
-Room 213, the vinyl covered striped chair had vinyl that was split on both right and left arm rests, the seat had a large stain and worn areas, and the legs were scuffed.
-Room 217, the vinyl covered striped chair had vinyl that was split on the right and left arms and the vinyl was split on the seat.
-Room 223, the vinyl covered striped chair had a yellow stain on the seat and the arm rest had worn vinyl, the B side chair had a vinyl striped chair with the seat stained and splitting of the vinyl on the arm rests.
-Room 224, the vinyl striped chair had split arms exposing threads on the right, and the seat had brown stains, the legs were scuffed and discolored.
-Room 228 A, the vinyl striped chair was worn with splits of the vinyl on the arm rest. -Room 231, the vinyl covered striped chair had splits and stains on the seat and the arm rest was worn with vinyl that was split.
-Room 234, the vinyl covered striped chair was worn on the arm rests. In the sitting room of the Phillips Unit the following was observed:
-The rug on the right side of the room had 2 ripples of lifting carpet.
-A plastic three drawer storage cabinet was on top of the desk area.

There were two small bins; one with crackers, another with condiments. Plastic rings from a game were present in the bins storing food. The top drawer of the plastic storage container had uncovered multiple plastic drink cups, uncovered. The second drawer had an individual box of dry cereal. The bottom drawer labeled Clothing protectors only had three hair brushes, a derma daily lotion container, a tennis ball, magazines, and many loose examination gloves. During interview with CNA #1 on 7/24/17 at 11:15 A.M., she said the sitting room area was used to keep extra nourishments for the residents. She said the food bins should not have the activity items placed there and the area should not have been in that condition.

2. During an environmental tour conducted on 7/24/17, from 11:00 A.M.-11:14 A.M., on the Hawthorne Unit the following was observed:
-Room 239 A, the vinyl striped chair had a split on the arms exposing thread.
-Room 244 A, the vinyl striped chair had a stain on the back rest, the seat was stained and both arms rest had splitting vinyl. In the sitting room on the Hawthorn Unit the following was observed:
-The rug was split in two areas, and other areas had worn tape that was placed over areas that had splitting of the carpet. The environmental tour continued on the Hawthorne Unit on 7/24/17 from 11:45 A.M.-12:10 P.M., with the Administrator present. The following was observed:
-Room 237, both vinyl striped chairs were worn and split on the arm rests.
-Room 252, had one vinyl striped chair with the seat stained and split.
-Room 254, the vinyl striped chair had 4 splits in the right arm rest.

The resident in this room said the furnishing could use some enhancement. Durng the environmental tour the Administrator said she had recently thrown out two chairs and confirmed that the condition of the chairs was not acceptable. During interview with the Administrator on 7/24/17 at 7:55 A.M. she said she was not aware of any specific plans the facility had related to the updates in the environment.

Failed to provide care by qualified persons according to each resident's written plan of care.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observations, record review and staff and resident interviews, the facility failed to follow a Physician’s order to elevate Bilateral Lower Extremities (BLE) while sitting for, 1 Resident (#11) in a total sample of 23 residents.

Findings include:

Resident #11 was admitted to the facility in 01/2016 with [DIAGNOSES REDACTED]. Review of Resident #11’s most recent Minimum Data Assessment ((MDS) dated [DATE], indicated he/she required assistance with transfers, bathing and dressing. Review of Physicians orders date 5/25/17 indicated: Elevate BLE while sitting, on each shift.

Review of Resident #11’s medical record indicated that Resident #11 was seen by a Nurse practitioner (NP) on 6/21/17 for weight gain/[MEDICAL CONDITION]. New treatment for [REDACTED].

On 7/17/17 at 8:30 A.M., Resident #11 was observed in his/her room seated in his/her wheelchair having breakfast. Both feet were flat on the floor. At 10:00 A.M., Resident #11 was observed seated in his/her wheelchair watching TV with BLE not elevated.

At 1:45 P.M. Resident #11 was observed seated in his/her wheelchair watching TV and knitting with BLE not elevated.

On 7/17/17 at 2:00 P.M., review of Resident #11’s Nurses Notes and Treatments indicated no documentation of Resident #11’s refusing elevation of BLE while seated. On 7/18/17 at 11:45 A.M., Resident #11 was observed in his/her room, seated in his/her wheelchair watching TV with BLE not elevated. At 2:00 P.M., Resident #11 was observed seated in his/her wheelchair watching TV with BLE not elevated. On 7/18/17 at 2:00 P.M., Resident #11 was interviewed as to whether the staff offered to elevate his/her feet while he/she was watching TV or knitting, Resident #11 replied NO. On 7/18/17 at 2:20 P.M., a Certified Nursing Assistant (CNA #1) was interviewed as to whether she was aware that Resident #11’s BLE needed to be elevated when sitting. CNA #1 said that she was aware and that Resident #11 refused most of the time. At 2:30 P.M., Unit Manager (UM #2) was interviewed. UM #2 told the surveyor that Resident #11 had been refusing the elevation of BLE most of the time since the order had been written. UM #2 was informed that no documentation of the resident refusing treatment could be found in the nurses notes or treatment record by the surveyor. UM #2 said that nurses should have documented each time Resident #11 refused the treatment.

0n 7/19/17 at 11:15 A.M., the Nurse Practitioner (NP) was interviewed. She told the surveyor that there is a Communication Book for the nurses and MD/NP, and the book is checked when they are on the unit. Review of the Communication Book with the NP indicated no documentation/notification that Resident #11 was refusing to elevate his/her BLE. The NP could not recall if she was notified by the nurses via phone.

Failed to assist those residents who need total help with eating/drinking, grooming and personal and oral hygiene.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, record review and staff interview, the facility failed to ensure that necessary services were provided to maintain proper grooming for 1 Resident(#17) in a total sample of 23 residents.

Findings include:

For Resident #17, the facility failed to provide necessary assistance with grooming. Resident #17 was admitted to the facility in 10/2016 with [DIAGNOSES REDACTED]. Review of the Minimum Data Set(MDS) with an Assessment Reference Date of 4/21/17 indicated that he/she had a Brief Interview for Mental Status (BIMS) score of 3 out of 15, indicating severe cognitive impairment. Resident #17 required extensive assistance of one person for grooming.

During observation 7/19/17 at 9:00 A.M., Resident #17 was in bed resting. He/she awoke with a smile and on both hands was a dark brown substance caked underneath the fingernails. During observation 7/19/17 at 2:00 P.M., Resident #17 was in bed watching television. He/she smiled when the Surveyor entered the room. On both hands was a dark brown substance caked underneath the fingernails.

During observation 7/20/17 at 11:30 A.M., Resident #17 was in bed watching television. He/she continued to have the dark brown substance caked underneath the fingernails on both hands.

The surveyor and Unit Manager #2(UM #2) observed the fingernails 7/20/17 at 11:35 A.M. During interview UM #2 said Resident #17 loves chocolate and that was what was seen under the fingernails. The UM #2 said the resident was resistive to grooming when attempted by nursing staff. The Behavior Flow Sheet documented the resident was resistive to care 2 shifts in the month of 6/2017. Psychiatric Progress Notes documented Resident #17 was calm and cooperative 4/7/17 and 7/14/17.

Failed to make sure that residents receive proper treatment and assistive devices to maintain their vision and hearing.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review, observation, and staff interviews, the facility failed to provide an assistive device to maintain vision abilities for 1 Resident (#10) out of a total sample of 23 residents.

Findings include:

Resident #10 was admitted to the facility in 7/2016 with [DIAGNOSES REDACTED]. On 7/19/17 at 4:10 P.M , Surveyor observed Resident #10 negotiate his/her wheel chair into the room. Resident #10 expressed concerns about only getting one TV channel – all commercials and news. Surveyor gave the remote to the resident and said do you want to change the channel? Just push the button with the cross on it. The resident replied that he/she could not see the button on the remote. The resident said that he/she could see the Surveyor’s out line but not specific features. The Resident stated that he/she use to have a magnifying glass at home and if he/she had one he/she could see better. Surveyor asked if he/she had requested one and he/she replied yes but never got one. Review of Section B1000 Vision of the 6/02/17 quarterly MDS coded Resident #10 as: 1. Impaired. Sees large print, but not regular print in newspapers/books. Section V: Care Area Assessment (CAA) Summary identified Vision as a triggered care area with a decision to not proceed to care plan and was described as:, slightly impaired vision no need to proceed (to care plan), no impact on overall status. No care plan for vision was generated. However, the Activities of Daily Living Care Plan, with a target date of 9/06/27, noted: Left eye impaired. No related intervention approaches were identified.

Surveyor reviewed the Resident’s Consult Reports and identified that on: 6/15/17, an Optometrist Visit Report on Resident #10, assessed the Resident as:

a. Legally blind from [MEDICATION NAME] Degeneration,

b. Cataract Right Eye, and c. Pseudoaphake (Intraocular lens)

Left Eye The report also included a new order recommendation for: a 5X Magnifier with Bright Light Source (Home Depot). On 7/19/17 at 4:30 P.M., an interview with the Unit Manager identified that no one had reviewed the Optometrist’s report and updated the physician. The UM also stated that the Activities Department had hand held magnifiers and she would follow up with the Activities Department.

On 7/20/17 at 1:15 P.M., interview with the Activities Director identified that the department did not have hand held magnifiers. On 7/20/17 at 8:30 A.M., interview with the Director of Nurses (DON), who stated that Home Depot was out of the magnifier and the facility had obtained a temporary magnifier for Resident #10 until the other was available.

Failed to properly care for residents needing special services, including: injections, colostomy, ureostomy, ileostomy, tracheostomy care, tracheal suctioning, respiratory care, foot care, and prostheses.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, medical record review and staff interview the facility failed to provide proper foot care and sufficient lighting to accommodate Podiatry Services for 1 Resident (#17) in a total sample of 23 residents.

Findings include:

Resident #17 was admitted to the facility in 10/2016 with [DIAGNOSES REDACTED]. During observation 7/19/17 at 9:00 A.M., Resident #17 was in bed resting. He/she awoke with a smile. His/her feet were not covered and the toe nails on both feet were very thick and elongated.

Review of the MDS with an Assessment Reference Date of 4/21/17 indicated that he/she had a BIMS score of 3 out of 15. The score demonstrated a severe cognitive impairment and Resident #17 required extensive assistance of one person for personal hygiene and grooming.

The Podiatrist progress note dated 12/28/16 indicated onychauxis (thickening of the nail) and onychomycosis (fungal infection of the nail) with a plan to reduce and debride the toe nails.

A Podiatrist progress note dated 3/22/17 indicated that staff requested the resident be seen in his/her room due to the inability to get out of bed. An assessment was completed and the Podiatrist recorded that the lighting was very poor in the resident room and very difficult to perform the service safely.

A Podiatrist progress note dated 6/14/17 indicated that the staff reported the resident was in bed and would not be coming down for treatment. A Podiatrist progress note dated 6/28/17 indicated the resident was assessed and unfortunately not treated due to very poor lighting in the resident room; it was very difficult to provide safe and quality care while the resident was in bed.

Secondary to insufficient lighting in the resident room, care and services were not completed for Resident #17 and the toe nails remain very thick and elongated. During observation and interview 7/20/17 at 11:35 A.M. UM #2 said she was unaware the Podiatrist needed additional lighting to perform the necessary foot care.

Failed to store, cook, and serve food in a safe and clean way.

Based on observation/inspection of the facility kitchen, and staff interview, the facility failed to ensure that food was stored, prepared, and distributed under sanitary condition.

Findings include:

The kitchen/food service observation was conducted by the surveyor with the Food Service Director (FSD) on 7/17/17 and 7/18/17.

The following kitchen sanitation issues were identified:

1. On 7/17/17 at 10:50 A.M., a coffee mug provided to the survey team was observed to have moderate amount of yellow dried food substance inside.

2. On 7/17/17 at 2:00 P.M., 2 Lip Plates and 1 small bowl on the clean side of the dish machine were noted to have a small amount of dried food on them. The FSD was informed of this finding.

3. On 7/18/17 at 8:15 A.M., 2 white plates and 2 small dessert plates on the clean side of the dish machine were noted to have small amounts of dried food on them. The FSD was informed.

4. On 7/18/17 at 11:35 P.M., the Surveyor observed the FSD not performing handwashing or wearing gloves while checking food temperatures at the steam table; surveyor intervened. The FSD said that he should have washed his hands and worn gloves before checking food temperatures.

Failed to maintain drug records and properly mark/label drugs and other similar products according to accepted professional standards.

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation and staff interview, the facility failed to ensure that all medications and biologicals were of current date to provide reliability of strength and accuracy of dosage in 2 of 3 medication storage rooms.

Findings include:

1. During inspection of the Glover Unit’s medication room on [DATE] at 12:10 P.M., the following expired items were observed.

-21 cans of Nepro (a nutritional drink for dialysis patients) expired ,[DATE] and ,[DATE]. Nutritional drinks are not to be consumed past the date of expiration.

-1 can of Osmolite 1.5 calorie (nutrition for tube feed patients) expired ,[DATE]. Nutritional tube feeding is not be consumed past the date of expiration.

-Tuberculin purified protein derivative (a diagnostic agent to detect [DIAGNOSES REDACTED]) multidose vial was opened and dated ,[DATE] in the medication refrigerator. The Tuberculin solution beyond- use-date was 30 days after first accessing the vial.

-Tuberculin purified protein derivative multidose vial was open and not dated in the medication refrigerator. The Tuberculin solution beyond- use- date was 30 days after first accessing the vial.

The Glover Unit Manager (UM #1) during interview said he was unaware these items were expired and would destroy them immediately. 2. During inspection of the Hawthorne Unit medication room [DATE] at 12:30 P.M., the following expired item was observed. -Novolin insulin (a medication to treat diabetes) multidose vial was open and not dated in the medication refrigerator. Insulin must be discarded after 28 days. The Hawthorne Unit Manager (UM #3) during interview said she was unaware the insulin was open and not dated. She would discard the insulin immediately.

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

Based on medication pass observation and staff interview, the facility failed to ensure that infection control guidelines were followed during medication preparation and administration.

Findings include:

A medication pass observation was conducted on 7/18/17 at 8:15 A.M. Licensed Practical Nurse #1 (LPN #1) performed hand hygiene and prepared prescribed medications for Non-sampled Resident #2 (NS #2).

LPN #1 entered the Resident’s room and administered the oral medications to NS #2. LPN #1 left the Resident’s room, returned to the medication cart and prepared the prescribed medications for Non-sampled Resident #3 (NS #3) without performing hand hygiene.

During interview LPN #1 said she should have performed hand hygiene before preparing the medications for NS #3.

A medication pass observation was conducted on 7/18/17 at 12:15 P.M. LPN #1 prepared an intravenous medication for NS #3.

LPN #1 entered the Resident’s room and donned gloves without performing hand hygiene. LPN #1 set the intravenous medication into the intravenous pump and primed the tubing. LPN #1 removed her gloves and prepared the intravenous site for flushing and attaching the tubing for infusion. She then donned gloves without hand hygiene, flushed the intravenous access with a 10 cc syringe of normal saline and attached the tubing for medication infusion.

Grosvenor Park Health Center, 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 Profiles and Reports – Grosvenor Park Health Center

Inspection Report for Grosvenor Park Health Center – 07/24/2017

Page Last Updated: March 24, 2018

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