Royal of Cotuit

Royal nursing home

MI Elder Abuse Free Legal ConsultationDid someone you love suffer elder abuse or neglect at Royal of Cotuit? 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 Royal of Cotuit

Royal nursing homeRoyal of Cotuit is a for profit, 120-bed Medicare/Medicaid certified skilled nursing facility that provides services to the residents of Dennis,  Yarmouth, Brewster, South Yarmouth, Harwich, Sandwich, Mashpee, Bourne, Wareham, Plymouth, Falmouth, Carver, Duxbury, Kingston, Marshfield, and the other towns in and surrounding Barnstable County, Massachusetts.

Royal of Cotuit focuses on 24 hour care, respite care, hospice care and rehabilitation services.

Royal of Cotuit
161 Falmouth Road
Mashpee, MA 02649

Phone: (508) 477-2490
Website: http://www.royalhealthgroup.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 2017, Royal of Cotuit in Mashpee Massachusetts received a rating of 4 out of 5 stars.

Performance Area Rating
Overall Rating 4 out of 5 (Above Average)
State Health Inspections 3 out of 5 (Average)
Staffing 4 out of 5 (Above Average)
Quality Measures 2 out of 5 (Below Average)

Fines and Penalties

Our Nursing Home Abuse Lawyers inspected government records and discovered Royal of Cotuit committed the following offenses:

Failure 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 observation, record review and staff interview, the facility failed to maintain professional standards of practice for 1.) the removal of a Peripherally Inserted Central Catheter (PICC) for 1 Resident (#9) and 2.) the administration of a narcotic for 1 Resident (#2), from a total of 15 sampled Residents.

Findings include:

According to the Board of Registration in Nursing, each nurse is required to practice in accordance with accepted standards of practice and is responsible and accountable for his/her nursing judgements, actions, and competency. The Board’s regulation at 244 CMR 9.03 (6) requires all nurses to comply with any other law and regulation related to licensure and practice.

Advisory Ruling Number 9301 indicates that it is not within the Licensed Practical Nurse (LPN) scope of practice to insert or remove a PICC.

Resident #9 was admitted to the facility in 7/2016 with [MEDICAL CONDITION] and a PICC line (a long intravenous access device inserted into a vein and advanced to near the junction of the right atrium), for IV antibiotic administration. Review of the Treatment Administration History form indicated that on 10/16/16 at 10:15 P.M. an LPN removed the Resident’s PICC line. The reason/comment section indicated: 50 centimeter (cm./ or approximately 20 inches) with intact tip and no signs/symptoms of bleeding.

On 11/9/16 at 2:00 P.M., the Surveyor interviewed the Administrator and Staff Development Coordinator (SDC). The Administrator and SDC pulled the LPN’s educational folder in an effort to find evidence of a completed PICC removal competency. None was provided to the surveyor.

Based on medication pass observation and staff interview, the nursing staff failed to ensure the safe administration of a narcotic medication, in accordance with current accepted professional standards for safe administration. The facility nursing staff administered the narcotic without a complete pharmacy label and therefore, without knowing the specific dose of the medication, over a period of 10 days, before Surveyor observation.

On 11/8/16 during the 2:00 P.M. medication pass observation, the Surveyor observed Nurse #2 remove a medication blister pack from the cart. The label on the blister pack indicated [MEDICATION NAME] 1/2 tab twice per day. The pharmacy label did not indicate the strength of the medication ([MEDICATION NAME] is an opioid narcotic containing [MEDICATION NAME] and hydrocarbon for moderate to severe pain). [MEDICATION NAME] has two different strengths of 7.5 mg [MEDICATION NAME]/325 mg [MEDICATION NAME] and 10mg [MEDICATION NAME]/325 mg [MEDICATION NAME]).

The Surveyor observed that the blister pack contained 20 1/2 tablets, however an unopened blister pack contains 40 tablets. Therefore, the staff administered 20 doses of [MEDICATION NAME] over a 10 day period, without knowing the exact dose being administered to the Resident.

Review of the physician’s orders [REDACTED].) ([MEDICATION NAME]/[MEDICATION NAME]), 1/2 tablet twice per day for pain.

The Surveyor observed Nurse #2 speak with the Nurse Practitioner (NP) at the nursing station. The NP wrote a new prescription and Nurse #2 called the Pharmacist and explained that the [MEDICATION NAME] was supplied without the complete dose on the label.

Failure 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.

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

Based on record review and staff interviews, the facility failed to conduct a comprehensive assessment of bladder function to ensure that all Residents receive appropriate treatment and services to restore as much normal bladder function as possible for 1 (#6) of 15 sampled Residents.

Findings include:

Review of the Bowel and Bladder Assessment and Retraining Program policy, dated 9/15/16, indicated that individualized bowel and bladder programs can be implemented by the nurse manager, charge nurse or nursing supervisor.

The documented objective for the Resident is to achieve control of bowel and bladder elimination on a regular basis, enhance independence and restore the Resident to the fullest potential to which he/she is capable.

The procedure included to assess the Resident’s bladder/bowel status upon a change in elimination, and establish a pattern of incontinence for 1 week (7 days) and adjust the Resident’s toileting plan as needed.

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

Based on observation and interview, the facility failed to ensure that proper food service sanitation practices were followed to ensure the chemical sanitation requirement for the 3 compartment sink (used for pots and pans) and cleaning cloths was monitored for effective concentration (according to the manufacturer’s specifications at 100-400 parts per million (ppm) to prevent the potential development of food contamination.

Findings include:

During the facility tour of the main kitchen with the Food Service Director (FSD) on 11/08/16 at 10:30 A.M., included the following observations:

Food service staff was observed washing food service equipment at the three bay sink. The Surveyor asked the FSD to test the chemical concentration of the sanitizer solution in the three compartment sink (where pots & pans are washed, rinsed and sanitized). The food service equipment is submerged in a solution of sanitizer and water in the third sink to destroy potential bacterial organisms.

The FSD used the (quaternary) test strips stored above the compartment sink. The test strips are designed to change color (color codes according to the manufacturer’s specifications included 100-400 parts per million) based on the concentration of the sanitizer when dipped into the sanitizing rinse water. The FSD checked the sanitizer solution by placing the test strip into the sink. The test strip failed to change color. The FSD repeated the test and the test strip failed again to indicate the presence of sanitizer. The FSD proceeded to use a new and unopened package of test strips, and again the test strips failed to detect the presence of any sanitizer. The FSD said that the service provider had checked the equipment on 11/3/16. Review of the service report, dated 11/3/16, indicated that the sanitizer in the three bay sink was recorded as 200 ppm. At 10:30 A.M., review of the sanitizer log sheet indicated that the sanitizer sink was checked for the breakfast and the afternoon meal times, both recorded at 200 ppm concentration. The FSD had no explanation for the log recordings.

The FSD and Surveyor, checked the distribution lines from the bottle of sanitizer and the hose water line at the sink and the FSD said that the line must have been twisted, therefore the proper flow of sanitizer was not reaching the rinse water to maintain an effective concentration (200-400 ppm) to destroy potential organisms and prevent contamination and potential food borne illness.

Failed to Safely provide drugs and other similar products available, which are needed every day and in emergencies, by a licensed pharmacist

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

Based on record review and interviews with staff, the facility failed to ensure that routine drugs were available and administered timely for 4 (#5, #10, #11 and #12) of 15 sampled Residents.

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.

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 medication pass observation and staff interview, the facility’s pharmacy failed to accurately label a controlled medication, in accordance with current accepted professional standards for safe administration.

Findings include:

On 11/8/16 during the 2:00 P.M. medication pass observation, the Surveyor observed Nurse #2 remove a medication blister pack from the cart. The label on the blister pack indicated Norco 1/2 tab twice per day. The pharmacy label did not indicate the strength of the medication (Norco is an opioid narcotic containing acetaminophen and hydrocodone for moderate to severe pain. Norco has two different strengths of 7.5 mg hydrocodone/325 mg acetaminophen and 10mg hydrocodone/325 mg acetaminophen).

The Surveyor observed that the blister pack contained 20 1/2 tablets, however an unopened blister pack contains 40 tablets. Therefore, the staff administered 20 doses of Norco over a 10 day period, without knowing the exact dose being administered to the Resident. Review of the physician’s orders [REDACTED].) of Hydrocodone/Acetaminophen, 1/2 tablet twice per day for pain.

The Surveyor observed the nurse speak with the Nurse Practitioner (NP) at the nursing station. The NP wrote a new prescription and the nurse called the Pharmacist and explained that the Norco was supplied without the complete dose on the label.

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

Based on observations during the medication pass, the facility failed to ensure that staff hand washing/sanitation was consistent with accepted standards of practice, to reduce the potential spread of infection and prevent cross-contamination.

Findings include:

On 11/9/16 at 1:15 P.M. with Nurse #1, the Surveyor observed medication administration to 6 different residents in 5 different rooms. The Nurse was observed to discard empty medication cups into a filled trash bin attached to the medication cart with bare hands (touching discarded trash). The Nurse was also observed to touch bedside tables, bed linens, the laptop on the medication cart and residents’ hands without sanitizing her hands.

The Surveyor shared the observations with the Nurse upon completion of her medication pass. The Nurse pulled an alcohol-based hand sanitizer from the bottom drawer of the medication cart and did not respond to the Surveyor.

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

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

Based on records reviewed and interviews, for 1 of 3 sampled residents (Resident #2), the Facility failed to notify the activated Health Care Agent (HCA) that Resident #2 had sustained a hematoma (bruise) above his/her left eye. On 5/28/17, Resident #2 was observed by facility staff to have a 2.5 centimeter (cm) hematoma above his/her left eye and Resident #2’s HCA was not made aware of the injury until he came to take Resident #2 home on 5/30/17.

Findings include:

The Policy titled, Change in Resident’s Condition or Status, dated 11/2015, indicated the Charge Nurse will notify the resident’s family when the resident is involved in any incident that results in an injury including injuries of an unknown source. The Policy titled, Accidents and Incidents-Investigating and Reporting, dated 02/2014, indicated all incidents involving residents occurring on premises shall be investigated, reported and the resident’s family is to be notified.

The Policy titled, Charting and Documentation, dated 04/2008, indicated all incidents or changes in the resident’s condition must be recorded and the family shall be notified. Review of Resident #2’s medical record indicated his/her medical history included dementia and his/her Health Care Proxy was activated.

Royal of Cotuit, 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: October 3, 2017

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