Massachusetts’ Attorney General has secured settlements with five Massachusetts nursing homes to resolve allegations of patient neglect, insufficient staff training, and inadequate care for vulnerable nursing home residents. The settlements will return more than $250,000 to the state, including more than half to the Massachusetts Department of Public Health (DPH) Long-Term Care Facility Quality Improvement Fund. The settlements also require important training and compliance requirements to ensure resident safety and proper response to medical emergencies.
Nursing home #1 will pay $52,000 to resolve allegations that in 2018, facility staff failed to appropriately turn and reposition a resident who was at high risk for pressure wounds for over five weeks. The resident’s health declined rapidly due to the pressure injuries, and she was admitted to the hospital where she died. The agreement also requires a compliance program to ensure staff are trained as part of new staff orientation programs and semi-annually on the appropriate provision and documentation of preventative skin care and repositioning, as well as annual self-audits and certifications of compliance.
Nursing home #2 agreed to pay $55,175 to resolve the allegations that they failed to comply with long-term care (LTC) regulations requiring facilities to train staff and maintain a program of preventative skin care; failed to comply with LTC regulations and provide quality care to residents; and committed the wanton or reckless neglect of a resident during her post-surgery rehabilitation, resulting in medically avoidable pressure injuries. The agreement also requires a three-year compliance program to ensure facility staff are trained on preventative skin care, as well as self-audits and certifications of compliance.
Nursing home #3 will pay $33,725 and enter a three-year compliance program to ensure facility staff receive mock code training on an annual basis and as part of new staff orientation programs, as well as self-audits and certifications of compliance. Investigators found that the facility had failed to conduct any Code Blue (patient medical emergency) trainings between May 13, 2016 and July 10, 2019, and failed to adequately conduct mock automated external defibrillator (AED) drills for its nursing staff from September 16, 2016 through July 10, 2019.
Nursing home #4 will pay $81,500 to resolve allegations that it failed to properly implement its continence care protocol for more than 10 residents, and that it failed to ensure staff competencies in bowel management protocols. The facility also failed to provide adequate and appropriate care to one resident, resulting in her hospitalization and death due to severe fecal impaction.
Nursing home #5 will pay $30,000 to resolve allegations that they failed to ensure that their staff were CPR-certified and trained on emergency response protocols and procedures. They also failed to report the significant health declines of one resident to a physician. Later, the facility failed to respond appropriately to that resident’s medical emergency or give proper CPR, and the resident died. The settlement agreement also requires a compliance program to ensure that staff provide all appropriate services to residents and adequately respond to medical emergencies.
Issue:
High quality and safe resident care should be the top priority when providing nursing home services. All staff should be well trained and knowledgeable in the policies and procedures that ensure implementation of high quality, safe care. Your QAPI program should have performance improvement plans for quality care issues that are known areas of weakness within your facility. Failure to meet standards for quality of care can result in poor outcomes for residents, citations for substandard quality of care, and fines and other sanctions.
Discussion Points:
- Review your policies, procedures, and staffing guidelines to ensure they are designed to result in provision of quality care for residents. Review your Facility Assessment as required by F838 to ensure it addresses the needs of all residents. Update your policies and Facility Assessment as necessary.
- Train staff on their responsibility to provide safe, high quality nursing care, or to provide support services that help meet resident needs. Document that these trainings occurred and file the signed document in each employee’s education file.
- Periodically audit to ensure staff are following policies for delivering safe, quality nursing care and support services. Ensure your Facility Assessment is current, thoroughly assesses the needs of all residents, and determines the resources required to provide high quality resident care and services. Review your QAPI initiatives to ensure that safe, quality care is monitored as an initiative of the QAA/QAPI committee.
