Nursing homes aren’t supposed to lose track of their patients. Nor are they supposed to delay notifying a doctor when a patient exhibits suicidal behavior.
But such were the findings of the state Department of Public Health regarding the 190-bed Westside Care Center on Bidwell Street in Manchester. The DPH fined the nursing home $12,000 for violating state regulations, health codes and state laws regarding the care of Westside patients, specifically for failing “to notify the physician when there was a significant change in condition and/or a need to alter treatment.”
The company that manages Westside Care Center, iCare, a Manchester-based nursing home management company, is no stranger to DPH consent orders or fines.
During the past nine months, the state Department of Public Health has fined iCare a total of $49,000, citing nearly half of its nine nursing homes for numerous violations.
The four nursing homes are Westside Care Center, Kettle Brook Care Center, Chelsea Place Care Center and Wintonbury Care Center.
The DPH has placed the nursing homes on probation, is requiring additional training be provided to staff, and ordered the hiring of an independent nurse supervisor who would report back to the DPH on the facilities’ progress. Other conditions were issued, depending upon the facility’s violations.
Westside manager Chris S. Wright, also president and CEO of iCare, recently signed a consent order with an attached 42-page exhibit outlining numerous violations of state laws and regulations. His signature “does not constitute any admission of any kind regarding the violations alleged” in the DPH investigation and consent decree.
Calls to Westside for comment were not returned.
Among the Westside violations, the DPH found the facility failed to ensure a comprehensive plan for four of 10 sampled residents with ideas of suicide.
The DPH faulted Westside for not developing a proper plan of care for a patient who had expressed a desire to die until after a nurse’s aide found the resident with a cable cord wrapped around his neck while attempting to jump out a window.
The state agency also identified a patient who lacerated her wrist with glass broken from a picture frame, who also stated, “I wanted to die, let it bleed.” Despite the patient’s declared suicidal intention, DPH said Westside’s nurses did not transfer or pursue a transfer of the resident to an acute psychiatric hospital as directed by a physician. Instead, a notation in her file stated that the patient “was no harm to self or others.”
Eleven days later, the same patient told a staff member that “she would not be seeing him anymore” and, upon returning to her room, proceeded to cut her wrist again, this time with a safety pin.
The DPH’s investigation found that Westside failed to contact a physician regarding yet another patient who, over a two-month period, indicated suicidal intentions several times.
The patient told staff that he planned “to jump in front of traffic.” He also called a public suicide hotline and on the third day was discovered in his room bleeding from his right wrist. The patient indicated “that he was trying to kill himself because he wanted to be sent to the hospital.”
However, no evidence was found that a physician was notified on any of these occasions. The staff did report the incident to Westside’s behavioral health manager, noting that it was the facility’s practice to refer to the manager as a “doctor.”
Escaping Patients
The DPH also found Westside didn’t provide a proper care plan for a cognitively impaired patient with a diagnosis of “delusions, schizo-affective disorder, bipolar type” who fled the nursing home without permission. The staff could not find the patient during a nurse’s 5:30 p.m. rounds one afternoon, and not until the next morning did Westside learn of that patient’s whereabouts from the patient’s conservator. The patient had spent the night in a hotel out of state.
Upon the patient’s return by taxi after his last elopement from Westside, the facility refused to readmit him.
Another patient, a paraplegic, also with a desire to leave the nursing home, was found more than a mile from the nursing home, propelling his wheelchair down a city street and “was reluctant to return, expressing dissatisfaction with the facility.” A month later the patient was found outside the nursing home, once in the rain.
