By Lauren Young
Staff Writer
A Minoa nursing home has been fined $22,000 by the state for patient care violations, ranging from leaving residents in soiled clothing to missed meals and medications.
Onondaga Center for Rehabilitation and Nursing, located on 215 East Ave. in Minoa, received the fine after the finding of numerous violations during a February 9 inspection of the facility by the New York State Department of Health.
Inspectors observed multiple residents left in soiled clothing, suffering from bed sores, having missed showers and medication doses, according to the state health department website. The facility was ordered to pay $22,000 within 30 days.
“We have surrounded the Onondaga administrator with an extremely strong support team in order to correct the issues that were noted in our February survey. Our two strongest regional team leaders, in administration and clinical services, are helping to oversee the on-site leadership team and both have made a significant impact operationally and in terms of clinical care delivery that we are confident will be evident in our next survey,” stated the facility. “Health care staffing is a crisis issue everywhere in New York State. There are simply not enough qualified care-givers to meet the rising level of need.”
Formerly known as the Crossings, this 82-bed home was bought last year by Centers Health Care, a Bronx-based health care chain that owns 53 nursing homes in New York, New Jersey and Rhode Island.
According to the inspection report, there were multiple deficiencies identified on the recertification survey, including repeat deficiencies in the areas of abuse, activities of daily living, pressure ulcers, bowel/bladder, staffing, medication storage and prompt notification of lab results.
When inspectors visited the home in February, it was being run by an out-of-state administrator who was unavailable on weekends, according to the inspection.
The facility was fined for 24 deficiencies, many of which were repeat deficiencies, according to the report.
Observations from the report include:
- Failure to investigate reports of abuse and neglect for two residents observed, one of which had shown repeated acts of violence toward staff and other residents, such as spitting and hitting.
- Lack of a comprehensive person-centered care plan for three of seven residents reviewed for bowel functioning.
- Facility did not ensure residents who were unable to carry out Activities of Daily Living (ADLs) received the necessaryservices to maintain good nutrition, grooming, personal and oral hygiene. Specifically, one resident had no documentation that she was toileted and showered for multiple days while another resident was observed multiple times in urine-socked clothing.
- Failure to provide appropriate treatment and care according to orders, resident’s preferences and goals. Specifically, one resident was observed without a positioning device as ordered, another resident’s medications were not given as ordered and weekly skin checks were not completed and another had abnormal labs not addressed in a timely manner.
- Failure to provide enough food or fluids to maintain a resident’s health for four of 15 residents observed.
- Facility did not ensure theestablishment of an infection prevention and control program designed to provide a safe, sanitary and comfortable environment. Specifically, one resident’s catheter was observed uncovered on the floor of her room on multiple days of survey. Another resident’s catheter tubing was observed lying on the floor beneath his wheelchair on multiple days of survey.
- Facility did not provide an environment free of hazards orsupervision and assistance to prevent accidents for one of six residents reviewed for Specifically, one resident reviewed fell and sustained skin tears to both arms and there was no documentation the resident was wearing Geri-sleeves (protective covering) as planned.
- Facility did not ensure seven of 20 residents reviewed for pressure ulcers received care and
services to promote healing and to prevent new pressure ulcers from developing. - Some residents did not get lunch until after 1:30 p.m. due to short staffing.
- One resident become so dehydrated that she was hospitalized, as there was no registered nurse on duty to provide fluid intravenously.
According to staff at the facility, short staffing is largely to blame for these patient care violations.
On January 24, the company’s corporate director of nursing was interviewed, where she stated there were “staffing challenges.” She said the evening shifts were the most challenging, as there was often one certified nursing assistant (CAN) for 40 people. According to the report, she said “I think they do what they can with what they have.”
During an interview with a CNA on January 24, she said she typically works with three other CNAs for 35 to 40 residents on day shifts and typically only one to two CNAs for the evening shift. She added that the center is “always short staffed,” and once worked an entire shift by herself, struggling to provide fluids to residents as she spent most of her day getting residents up.
During an interview with a registered nurse (RN) on January 25, some treatments could not be completed on multiple occasions as there was only one nurse passing medications to 40 residents.
On January 27, a licensed practical nurse (LPN) stated she worked every weekend and frequently worked with just herself passing medications to 40 residents. Sometimes there was no time to get treatments done as she was busy getting all the medications passed.
On February 6, an LPN said it was “difficult to get everything done when she was the only nurse on the floor,” stating that she tried to prioritize and pass medications first, but was also responsible for calling physicians, answering phones, doing treatments and she also had one resident discharged and another on the way for re-admission. She stated no other nurses came to help her the entire day.
On February 7 an RN was interviewed, stating that it was “physically impossible” to pass medications to 40 residents by herself and complete all the treatments as well.
During an interview with the NP that same day, she stated medications were not given to residents as ordered because there was either a shortage of nurses or the nurses on the unit were not familiar with the residents and their needs. She also stated that her orders “were not being carried out” — an “ongoing issue” at the facility.
During a telephone interview with an RN on February 8, she stated she worked as an evening supervisor from 3 p.m. to 11 p.m. and could not perform her duties as a supervisor if she was also responsible for passing medications. Some of her duties included assessing falls, starting and monitoring IVs, pronouncing death and communication with the medical staff when there were changes in condition and staff oversight. She stated staffing was “not good on evenings” and she was “fearful.”
In a statement from the Centers Health Care and Onondaga Center, it was stated that the administrator initially hired is a traveling administer, licensed in New York, who they “rely on from time to time for temporary duty while [they] conduct a thorough search for a qualified, local candidate.”
The company has since hired an interim administrator, to which they stated that during that entire period, the Director of Nursing (DON) “was a local resident and was available 24/7.”
That DON has since been replaced by “a very capable nurse who is also local and available 24/7.”
The current administrator is Bonnie Shippee, a native New Yorker from the Central New York region.
The facility’s staffing, the company said, is becoming “one of the emerging strengths of Onondaga Center,” earning a 4-Star staffing rating on the Centers for Medicare & Medicaid Services (CMS) website.
In March/April, the state Department of Health re-surveyed the facility and found that leadership had “corrected the underlying issues” and that “sufficient staffing levels were being maintained.”
The facility additionally noted that its number of employees was “misleading,” as “every shift requires varying staffing levels, and their 4-Star rating “attests to the fact that we are over performing relative to state and national levels 24/7.”
The facility said, upon taking over the nursing and rehabilitation center, they have “put a number of initiatives in place, including a fluid distribution program to ensure proper hydration with fluid checks performed multiple times each day.”
Additionally, the facility acknowledged issues with pressure ulcers by bringing in Wound Care Solutions, an independent wound care physician’s group, and have established a rounding schedule and increased in-service training supported by “[an] aggressive follow-up to make certain that our residents are wound free.”
The facility said it is “confident” that their next survey will prove the efficacy of their efforts, which they said is “ongoing.”
