Thomas MacMillan File Photo
Surprise inspections to the West Rock Health Care Facility found medical records in cardboard boxes sitting in pooled water. One patient was wearing dirty clothes and sleeping in soiled sheets. A staffer used a “fecal smeared washcloth” to wash a patient’s open ulcer.
Faced with these findings, the state has decided to close the West Rock nursing home — eliminating 90 jobs and sending families of 79 patients looking for a new place to live.
Employees and patients at the West Rock Health Care Facility on Level Street were informed of the pending shutdown on Friday. The announcement came less than a month after the State Department of Public Health (DPH) documented 37 pages of violations regarding patient care and procedures at the facility. That report was sent to West Rock on April 6, after six unannounced DPH visits at the end of March and beginning of April.
Read the report here.
The DPH findings preceded an order to close the home, the final blow to the private nursing home, which has been struggling for months to stay afloat.
The trouble came to light last December, when West Rock filed for bankruptcy. Since nearly all the facility’s patients are on Medicaid, the Department of Social Services began to monitor the facility to make sure patient care did not deteriorate.
After the DPH report at the beginning of April, New Haven attorney Barbara Katz was appointed on April 12 as trustee in charge of West Rock. Katz brought in a new administrator and chief operating officer. On April 23, she filed a motion in bankruptcy court to “wind down and cease to operate the debtor’s nursing home facility.” Read the motion here.
The bankruptcy court approved the motion on April 29. On April 30, staff and patients were told the nursing home is closing.
Katz could not be reached for comment.
According to David Dearborn, spokesman for the Department of Social Services (DSS), the facility will close as soon as new homes can be found for its 79 patients, many of whom need long-term care for mental illness and physical disabilities. Over 90 employees will be let go.
Dearborn said planning for the 79 patients’ care will be done by staff at West Rock in cooperation with DSS, DPH, the Department of Mental Health and Addiction Services, and the Department of Developmental Services.
“Efforts will be made to place individuals in the community,” Dearborn said. Planners will make use of the Money Follows the Person program and other home care programs, he said. Patients will also be transferred to other nursing facilities.
37 Pages
The DPH visits to West Rock at the beginning of April resulted in 37 pages of violations, from failure to keep adequate records to failure to clean and care for an incontinent patient.
According to the report, West Rock staff “failed to provide the necessary care and services for each resident to prevent neglect.” One patient’s records showed a decline in mood and an increase in depression and isolation throughout 2009. But “new interventions were not identified.”
When DPH observers visited the patient at 10:30 a.m. on March 29, they found the patient “sitting on his bed which was unmade and with an accumulation of soiled sheets. The resident’s hair was quite greasy and unkempt. He/she was wearing an extremely soiled shirt.”
Stained sheets were a widespread problem at the facility, the report states. “The linen on the residents’ beds was worn thin and generally brown tinted,” the report reads. “An observation of two linen closets identified that the majority of clean linens were worn, stained, and brown in color.”
DPH found a lack of proper procedures with regard to infection. One resident was found to have a “Stage IV pressure ulcer,” or bed sore, at the base of his or her spine. The patient was also incontinent. A DHP observer saw a West Rock staffer cleaning the patient wipe a “fecal smeared washcloth up and over the resident’s Stage IV sacral pressure ulcer.” The staffer did it twice before the observer stepped in to stop her. An interview found that the staffer did not have an understanding of “infection control practices during incontinent care.”
In another infection-related violation, DPH observers found a West Rock staffer using a catheter improperly, creating “increased risk for backflow of urine.”
West Rock did not have secure and organized medical records, the report states. At 12:50 p.m. on April 3, observers noted cardboard boxes of medical records stored on the ground level. Pooling water on the floor had soaked through several of the boxes.
Other violations were found with regard to responding to patient needs. Meals and medications were not given out in a timely fashion. Staff did not report or investigate a “potentially self-injurious incident” involving a patient drinking shampoo. One patient’s 16.5 pound weight loss in 12 days was recorded but went unchecked, even though the facility’s policies required follow-up on weight fluctuations of five pounds or more in a 30-day period.
Asked if the findings at West Rock were egregious in relation to other DPH inspections, spokeswoman Diana Lejardi said, “Not really.”
“It’s not out of the ordinary to see deficiencies like that,” she said.
Can’t Stay Open, Can’t Be Sold
Trustee Katz’s April 23 motion to close West Rock spells out the reasons the facility should be shut down.
“The trustee has determined that there are sound business reasons to close the facility,” the motion states. Closure is in the best interests of patients as well as creditors to the facility, the motion states.
The motion cites a letter from Janet Williams, public health services manager for DPH, who wrote after the West Rock inspections that “regulatory violations were systemic and extensive and were a manifestation of the incompetence of the clinical and administrative management of the facility.”
Due the severity of the violations and its lack of money, West Rock is not in a position to fix its problems, the motion argues. “The Debtor simply lacks the necessary financial resources and [has] no reasonable prospect for obtaining such resources in the near future.”
According to the motion, Katz considered and rejected the possibility of selling West Rock for several reasons.
First, the state has an excess of nursing home beds and a lack of demand for nursing home services, the motion states. Competition for patients is very high, and West Rock was unable to find new patients even before the trustee was appointed.
As evidence of West Rock’s desperation for patients, the motion states that the nursing home took in “illegal aliens from a local hospital who are ineligible for any source of public payment.” West Rock also admitted patients “whose complicated health care conditions were far beyond the level of services historically provided at the Facility and beyond the developed skill set of staff.”
Sale of the facility would be further complicated by the fact that the buyer would need to remedy all the violations found by DPH, the motion states. “Equally important, any buyer would inherit the highly negative quality of care history of the facility with state and federal regulators. This significantly impacts the marketability of the facility including the ability of a new owner to bring in professional staff willing to work in a facility with a very negative care reputation.”
Furthermore, the facility is old and has physical plant problems, the motion argues. A patient care ombudsman report is quoted describing the grounds as “poorly kept” and the interior of the building as “equally depressing, with cinderblock walls, no color or pleasant aesthetics of any sort. … West Rock has the ‘look and feel’ of a minimum security correctional facility.”