Joye Law Firm

Friday, July 17, 2020

Resident Suffers Four Hours Without Care

Patewood Rehabilitation & Healthcare Center has been cited after a resident waited more than four hours to have their adult diaper changed. The resident requested help multiple times, and no nursing home staff assisted in this time.

A Certified Nursing Assistant (CNA) responded to the resident’s call light in their room at 8:00 am. The CNA told the resident that the staff was in the middle of passing out breakfast trays, and that she would come back soon to help. The CNA returned at 10:45 am and provided perineal care, but did not complete the morning care that the resident had requested more than two hours prior. The CNA told the resident, yet again, that they would return in two hours. When the CNA failed to show in the next two hours, the resident called again for help. The resident’s son and family visited in the middle of the day and noted a distinct smell in the room, as if the resident had not been changed regularly. The resident eventually got help at 3:00 pm, four hours and fifteen minutes later.

The CNA stated that they came to help the resident a few minutes after 3:00 pm because they saw that the resident’s call light was on. The CNA said that the resident was yelling and cursing when they arrived, shouting that four CNAs had ignored the call light. The CNA told the resident that they had no control over other aides and that they did not know the resident had waited for over an hour, but that they would help change the resident. According to the CNA, the resident continued to yell, so they asked for help from another CNA and a Licensed Practical Nurse (LPN).

The nursing home’s internal investigation states that when the CNA came to help the resident at 3:00 pm, a verbal altercation ensued. An LPN asked the CNA to leave the resident’s room. The LPN’s statement showed that the resident was crying, saying that their light had been on for a long time with no response. The resident claimed that they had not received care for hours and could smell themselves. Instead of responding to the resident’s concerns, the CNA insulted the resident and pointed their finger, arguing loudly with the resident. The LPN had to ask the CNA to leave the resident’s room numerous times before they walked out, slamming the door as they left.

The resident shared with the nursing home’s social services that they were shaken up by the incident, fearing that the CNA would try to come to the nursing facility and harm them. The psychological effects of nursing home abuse can last long past a specific event. This resident trusted the nursing home and nursing staff to care for them in their most vulnerable moments, and that trust was betrayed when one CNA failed to provide daily care. Other nursing staff also ignored the resident, even when their call light was active for more than an hour.

The CNA stated in an interview with the state investigator who compiled this citation report that this specific resident needed their vital signs taken every two hours because they had a fever. They also claimed that they changed the resident every time vital signs were taken, which was not the situation the resident or other nursing staff had described when reporting this incident. In the statement of one nursing staff member, the resident shared that their call light had been taken by the CNA.

The facility’s investigation did find the resident’s claims of neglect to be substantiated. In this case the resident’s reported neglect was witnessed by other staff members as well as their families. When a nursing home provides poor care to one or more residents, it is important that residents and their families speak up. Knowing the signs of abuse and neglect is the first step to protecting loved ones in a nursing home. This resident’s family was able to recognize a sign of neglect – a foul smell in a resident’s room – and the resident reported the issue to the facility.

Don’t wait. Get help for nursing home abuse today.

If you suspect nursing home abuse, we will provide a free, confidential case evaluation with no obligation to hire us. With nearly 250 years of shared experience, Joye Law Firm attorneys are consistently recognized by clients and peers at the highest level of professional excellence. We make sure to fight hard for our clients and are honest with them every step of the way.

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Florence Nursing Home Cited After Failing to Respect Resident’s End of Life Wishes

Commander Nursing Center in Florence, SC, has been cited after state investigators found that the facility “failed to ensure [a resident] had the opportunity to make a health care decision.” In this situation, the facility took a Do Not Resuscitate order signed by a family member without the required signatures from two physicians to determine the resident’s ability to make their own decisions.

The resident’s health changed, requiring cardiopulmonary resuscitation (CPR). The nursing home did not administer CPR, and the resident passed away. The state investigator found a form from South Carolina Emergency Medical Services, signed by a family member, directing medical providers not to intervene in a situation such as this.

The form did not, however, have the signatures from two physicians. The nursing home did not have record of a physician’s order in their electronic records, so multiple staff members looked through their written files for two hours while the state investigator continued to interview nursing home staff. They did not have a physician’s order for Do Not Resuscitate.

This is an essential part of a Do Not Resuscitate order; individuals must be able to make their own health decisions unless they have been reviewed as unable to make their own decisions regarding medical care. A family member may have their loved one’s best interests in mind, but they are not qualified to decide whether or not their loved one can make their own health decisions.

Advance directives, or wishes of an individual regarding their own death, are to be protected and correctly observed. The facility’s policy clearly stated that they should “adhere to residents’ rights to formulate advance directives,” communicating these wishes clearly in every document relevant to a resident’s medical record. Not only were nursing home staff working from an invalid form to care for the resident, but they also struggled to sort through different sources of medical information about the resident. All information in a resident’s medical record should be accurate and consistent between physical and electronic records throughout the nursing home.

The facility also failed to tell the resident’s physician of their change in health. The nursing home called the physician after the resident passed, rather than as their health was failing. The resident’s physician and responsible representatives, such as a family member, should be notified immediately of changes to a resident’s health.

The facility was given a citation code by the state of “immediate jeopardy.” This is a serious level of offense and is often the subject of the citations discussed in this legal blog. The nursing home did submit a correction plan. This plan included a thorough investigation of the records of residents deemed at risk of passing. They would assess the accuracy of these records and notify physicians and resident representatives of the records they had on file.

Commander Nursing Center also created an educational plan for its staff, including the immediate changes the nursing home was making to advance directives and code status. The facility promised to include a review of this policy in their daily morning meeting. The nursing home also planned to monitor the effectiveness of their new measures every week for four weeks and perform a Root Cause Analysis to identify root cause and immediate interventions if a break in policy was identified.

Commander Nursing Center has been cited previously and discussed in a number of our earlier legal blog posts. The facility has been cited for the abuse of a resident in relation to toileting needs, for multiple cases of mishandling instances of abuse, and has been noted as a Special Focus Facility in South Carolina.

Don’t wait. Get help for nursing home abuse today.

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Thursday, July 9, 2020

Facility Fails to Protect Memory Care Resident

Prince George Healthcare Center in Georgetown has been cited because “the facility failed to
make sure that the nursing home area is free from accidental hazards and risks and provides supervision to prevent avoidable accidents.” Because of this, a resident was put in immediate jeopardy.

According to the inspection report, the resident often wanders around the facility. She also often tries to leave the facility, “attempts to void in inappropriate places/trash cans,” and “prefers to sleep on [the] couch in the main area at times.”

With the resident’s needs in mind, the goal of her care plan was to “let her wander safely within specified boundaries.” The approaches listed in the resident’s care plan to attain this goal were to:

– Remove the resident from others’ rooms and unsafe situations when she wandered.
– Approach the resident from the front and walk in step with her before redirecting her.
– Provide the resident with activities based on her prior lifestyle, like folding towels.
– When resident begins to wander, provide comfort measures to make sure her basic needs (i.e. pain, hunger, toileting, etc) are being taking care of.

On multiple occasions, the resident was combative and redirection was unsuccessful. She often wandered in and out of other residents’ rooms, tried to undress, looked for exits, and ran down halls, sometimes with her pants around her ankles. Staff had difficulty redirecting her, and ended up having to medicate her to go back to bed on many occasions.

On on occasion, the resident attempted to find exits several times. The alarms sounded and staff were able to stop her, but it was very difficult to redirect her. Another time, she was wandering the halls in just briefs and shirt looking for exits. She held the door until the alarm sounded, then would try another exit down the hall until that alarm would sound. Sometimes she was easily redirected, and others she was very difficult.

According to the incident report, she wandered into a day room and removed her pants over a trashcan. She was redirected to her own room by staff. This same shift she was redirected from several other rooms, but was not combative. It wasn’t uncommon for her to try to take her clothes off, which was sometimes resolved after toileting. She was often confused and in others’ rooms, but not combative and didn’t affect anyone directly.

However, this wasn’t always true. The resident was, in multiple instances, combative and put herself and other residents at risk.

According to the report, the resident had chased a staff member out of a room agitated, forcefully grabbed the arm of a visitor, and been combative during care from nursing home staff. She had wandered from room to room, tried to push a resident out of their own room and scratched their hands before being redirected, upsetting the other resident.

Another incident reported the resident running down the hall and into a room where she hit her head on a door, resulting in a laceration above her left eye. Staff applied sterile strips and reported no other injuries. Later that day, the resident was running around the unit again, very unsteadily. She was looking for exits, entering others’ rooms, rummaging through drawers and was very difficult to redirect.

Another day, the resident tripped over a wheelchair when running in a day room. Nurses reported she did not hit her head and had no apparent injuries. They attempted to get her to wear a safety helmet, to which she refused, though she wore elbow and knee pads when tolerated.

In another incident, after making several exit attempts, the resident was running up and down the halls and in and out of other residents’ rooms. She later defecated on the floor.

A few days later, a nurse heard screaming from the resident’s room. Her roommate was on the floor, resident standing nearby. The resident’s roommate said “I was going to come out of the room and come down to the dining room when she came behind me and pushed me down.” When asked if she had pushed her roommate down, the resident mumbled indistinctly and did not answer the question directly. The nurses separated the residents.

Later that day, the resident refused incontinence care twice. Visibly agitated and anxious, she went to sit in a dining chair, tipping over. Nurses report she did not hit her head or sustain any other injuries.

The resident had shown the need for close supervision multiple times, causing distress and harm to herself and others. These accidents could have been easily prevented if the nursing home facility had placed this resident under closer supervision.

Prince George Healthcare Center has also been cited for failure to “provide and implement an infection prevention and control program.” The facility’s violations involved improper catheter care hygiene, improper contact precautions, wound care contamination and placing respiratory care materials on the floor. This is especially pertinent today in the age of COVID-19. The facility has had at least one confirmed case of COVID-19.

Don’t wait. Get help for nursing home abuse today.

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Commander Nursing Center Fails to Protect Residents From Abuse & Neglect

Commander Nursing Center was cited after the facility “failed to ensure that all residents remained free of abuse/neglect.” The facility did not do four vital things after three residents brought forth allegations of abuse/neglect:

1. Identity allegations/complaints as abuse/neglect;
2. Immediately implement safeguards to prevent further violations;
3. Report the allegations to appropriate authorities within the required time frames;
4. Conduct thorough investigations for the 3 residents who reported abuse/neglect.

According to the citation, staff members failed to assist Resident #1 with using the restroom when they requested help. Instead, staff members instructed the resident to use their disposable brief, which “would reasonably result in shame/humiliation.”

According to a Social Service note, the resident stated they put their call light on to get help using the restroom. When a Certified Nursing Assistant (CNA) answered the call light, the CNA told the resident to use the brief they were in. When the resident stated they would be wet, the CNA said “just do it.” The resident then wet themselves. The note also stated that the CNA was very short with the resident, but it’s not the first time the CNA has been “ugly” towards the resident.

Resident #2 reported that staff members were “rough and spoke abusively at times.” The resident was in a lot of pain due to previous broken hips, one of which was now inoperable and caused the resident “excruciating pain.” According to the resident’s complaint, a CNA was often rough with the resident and “fusses” with the resident at times. The investigator of this citation asked the resident how it made them feel when the CNA was rough with them; they began to cry and could not answer.

The investigator then interviewed the Director of Nursing (DON) regrading the rough handling. She stated she had not identified the CNA’s actions as abuse or “investigated [the complaint] as an allegation of abuse/neglect.” The DON said she talked to the staff, but there were no written statements.

Resident #3 did not receive help for incontinence over a 9 hour period. The resident stated they sat in a wet brief with a puddle under their chair from 7 AM to 4 PM. The resident also said that no one checked on them throughout the morning; the cubical curtain is usually pulled between them and a roommate, and the staff “does not usually come in to check on [the resident].” Documentation from the DON stated the following regarding the allegation: “After talking with staff, this did not occur. Resident experienced intermittent confusion.”

According to the citation, “There was no evidence of how the DON came to this conclusion. There was no evidence of any investigation of the complaint. There were no documented subsequent interviews with the resident in an attempt to validate the information. There were no written statements by staff or documented staff or roommate interviews. There was no evidence that the incident was reported to the State Agency.”

When abuse/neglect allegations come forward, there are many steps facilities must take to ensure the safety the residents. Commander Nursing Home’s neglect and abuse policy states the following:

When abuse, neglect, or exploitation is suspected, the Licensed Nurse should:

– Respond to the needs of the resident and protect them from further incident (document).
– Notify the Director of Nursing and Administrator (document).
– Initiate an investigation immediately.
– Notify the attending physician, resident’s family/legal representative and Medical Director.
– Obtain witness statements.
– Contact the State Agency and the local Ombudsman office to report the alleged abuse.

For all three residents, the proper procedures were not followed.

Don’t wait. Get help for nursing home abuse today.

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Wednesday, July 1, 2020

Nursing Home Fails to Notify Physician of Possible Eating Disorder

Blue Ridge of Sumter was cited after the facility “failed to notify the physician of [the] presence of multiple daily episodes of behaviors, specifically chewing on clothing and/or linen to the point of destruction.” These behaviors indicated the presence of pica, an eating disorder involving the consumption of things not typically thought of as food; it often occurs in people with other mental health disorders. The lack of follow-up put the resident at risk for consuming harmful substances that could result in severe stomach problems.

The resident in this citation was admitted to the facility with “unspecified intellectual disabilities… and specified developmental disorder of motor function.” He was known to be nonverbal and “unable to participate independently with individual or group activities related to cognitive deficits and physical deficits.” The resident also exhibited recurrent, destructive behaviors; he would chew on his clothing or linens to the point where the cloth would shred. This resulted in the release of threads that could be breathed in and/or swallowed by the resident, resulting in gastrointestinal complications.

An observation of the resident was conducted in regards to his behaviors. The investigator observed the resident lying in bed chewing on a damaged hospital gown. This behavior observation was immediately verified by a Licensed Practical Nurse (LPN). The investigator reviewed the resident’s medical record, looking for notes about the resident’s chewing habits. Only a social worker’s notes revealed the resident’s ongoing chewing of garments and linens. Upon interviewing a few Certified Nursing Assistants, the investigator discovered the resident had to have his gown changed once per shifted because of his chewing behavior.

The investigator then interviewed a nursing home physician. The physician stated she was not aware of the resident’s chewing issues, referred to as “pica” by the staff. Pica is an eating disorder that involves eating items that aren’t typically considered food such as hair, dirt, material, etc. The physician stated the resident must be hungry, so she would try giving the resident double portions. When the investigator asked whether or not the physician considered the chewing a behavioral issue, she stated “when someone tries to put something in their mouth… it usually means that they are hungry.” The investigator asked if the resident had recently been seen by a psychiatric specialist. She said she didn’t remember the resident being seen by anyone else; he had been at the facility for a long time.

At the conclusion of the physician’s interview, the resident was seen sitting in direct view of the physician, actively chewing on a blanket. The physician didn’t identify the behavior as pica but agreed the resident was chewing on the blanket. A new order was initiated for the resident to get double portions for lunch and supper. The facility also planned to refer the resident to appropriate professionals who could evaluate the resident’s pica-related behavior.

Don’t wait. Get help for nursing home abuse today.

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Nursing Homes Incorrectly Uses Hoyer Lift, Results in Broken Bones and Lacerations

Honorage Nursing Center in Florence, SC, has been cited after state investigators found that the facility “failed to protect [a resident] for abuse/neglect.” In this situation, a resident was transferred inappropriately with a Hoyer Lift, resulting in skin lacerations and broken bones.

According to the nurse’s notes, a nurse had been called to a resident’s room by a CNA Nursing Assistant). When the nurse entered the room, the resident was in the Hoyer Lift incorrectly, and the lift was tilted sideways. The right front Hoyer pad was not attached to the Hoyer.

The CNA explained that she was using the Hoyer Lift to transfer the resident from their wheelchair to bed, but “the front bar which holds the Hoyer pad tilted sideways and the right front Hoyer pad hook slid off the metal bar of the Hoyer lift.” The CNA and nurse eased the resident to the floor. Another staff member helped the nurse and CNA assist the resident back into bed.

When the Hoyer lift fell, the resident ended up with a 1 inch deep laceration on their left lower leg. The resident also complained of pain in their right arm. The resident was taken to the ER (emergency room). X-rays showed that the resident’s right shoulder and elbow were fractured.

In an interview with the surveyor, the LPN (Licensed Practical Nurse) stated that one of the straps was not attached to the Hoyer Lift. It wasn’t torn or damaged but had not been hooked correctly. The nurse stated she spoke to the CNA and asked if she had any assistance when attempting to move the resident. The CNA said she could not find anybody to help and attempted to lift the resident alone. The nurse told the CNA she should never lift a resident by herself, and showed the CNA how the pad attached to the lift properly to prevent a strap from slipping off the hook.
Review of the nursing home facility’s Policy and Procedure on how to use the Hoyer Lift revealed:

The Hoyer lift is operated with two facility employees present at all times while resident is being transferred. Lift Pads are to be placed under the resident while in bed. Prior to transfers make sure chains/straps are properly secured to Hoyer lift bar. Do not attempt to operate the Hoyer Lift alone or with the assistance of family members, friends or volunteers.

Don’t wait. Get help for nursing home abuse today.

Policies and procedures are in place to prevent the mistreatment, neglect and abuse of residents.
It is important that nursing home facilities follow these policies and procedures to protect their residents. In this case, failure to use the Hoyer Lift as instructed resulted in harm to a resident that could have been completely preventable.

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Friday, June 5, 2020

OSHA Issues Guidance to Help Construction Workers During the Coronavirus Pandemic

As businesses re-open after closures during the coronavirus pandemic, there is more risk for workers to be exposed to the COVID-19 coronavirus, the South Carolina Department of Health and Environmental Control (DHEC) advises in a recent update. That makes it more important than ever to focus our efforts to minimize the spread of this virus.

The U.S. Department of Labor has issued OSHA guidance and created a webpage dedicated to COVID-19 to assist the construction industry as it returns to work in South Carolina and across the country.

OSHA says the guidance is intended to keep construction workers safe but imposes no new legal obligations on businesses.

“It contains recommendations as well as descriptions of mandatory safety and health standards. The recommendations are advisory in nature, informational in content, and are intended to assist employers in providing a safe and healthful workplace.”

The recommendations featured in an accompanying OSHA news release include:

Keeping in-person meetings including toolbox talks and safety meetings as short as possible, limiting the number of workers in attendance, and using social distancing practices
Requesting that shared spaces in houses or occupied office buildings where construction activities are being performed have good air flow
Staggering work schedules to reduce the total number of employees on a job site at any given time and to ensure physical distancing.

How Has COVID-19 Impacted the Construction Industry?

The full economic impact of the coronavirus pandemic on the construction industry in South Carolina has yet to be determined. A report by Colliers International, a real estate services and investment management company with offices in Charleston, Columbia and Greenville, indicates what a global concern construction in the Palmetto State has become. The report’s synopsis reads:

The effects of the coronavirus, COVID-19, are being felt in South Carolina with a growing uncertainty regarding the virus and its ancillary effects on the economy. The severity of the impact of COVID-19 on South Carolina’s construction industry will be determined by the virus’s effect on the globally interconnected workforce, with primary emphasis on manufacturing employees and construction workers with the Port of Charleston or any other seaport caught in between.

MidlandsBiz, an online business magazine focused on Columbia, says in an article that quotes the Colliers International report that a reduction in Chinese manufacturing and shipping was felt early in the pandemic in the U.S. market. The article quotes Jim Newsome, CEO of the South Carolina Ports Authority, as anticipating a 15% drop in volume during March and April. Various material suppliers announced price increases ranging from 5% to 10% on gypsum board, fiberglass panels, acoustical ceiling tile, metal studs and paint.

“In a best-case scenario, it should be anticipated that the industry will experience temporary price increases and prolonged lead times on certain materials. If the worst happens, the ability to deliver projects on time and on budget may be in jeopardy. Proactive, professional management of construction projects and staying abreast of current trends will be critical to success in either scenario,” the report says.

Among the steps MidlandsBiz recommends for those planning to develop or renovate properties is to “protect workers from infection by following recommendations issued by the Centers for Disease Control (CDC).”

How Can Construction Workers Protect Their Health and Slow the Spread?

Among the recommendations from OSHA and the CDC for construction workers are:

Notify your supervisor and stay home if you have symptoms. Notify your supervisor if you have a sick family member at home with COVID-19 and follow CDC-recommended precautions.
Limit close contact with others by maintaining a distance of at least 6 feet, when possible. Limit the number of workers in small workspace areas, such as job site elevators, trailers and vehicles, and spaces under construction, if possible.
Use closed doors and walls, whenever feasible, as physical barriers to separate workers from any individuals experiencing signs and/or symptoms consistent with COVID-19. Consider erecting plastic sheeting barriers when workers need to occupy specific areas of an indoor worksite where they are in close contact (less than 6 feet) with someone suspected of having or known to have COVID-19.

How Employers of Construction Workers Can Slow the Spread

Among the recommendations from OSHA and the CDC for construction employers are:

Have a COVID-19 response plan to protect workers that follows CDC Interim Guidance for Businesses and Employers, and share this plan with employees and contractors in languages they all understand.
Conduct toolbox talks on all job sites to explain the protective measures in place.
Provide employees with access to soap, clean running water, and materials for drying their hands or, if soap and water are not readily available, provide alcohol-based hand sanitizers containing at least 60% alcohol at stations around the job site.
Modify work schedules to stagger work, provide alternating workdays or extra shifts to reduce the total number of workers on a job site at any given time.
Screen calls when scheduling indoor construction work to assess potential exposures and circumstances in the work environment before worker entry.

Pre-existing OSHA standards (29 CFR 1926 Subpart E) require that employers provide personal protective equipment (PPE) required by the job. On the new webpage, OSHA says, “Most construction workers are unlikely to need PPE beyond what they use to protect themselves during routine job tasks.”

Are Construction Workers Protected If They Get Sick on the Job?

A recent report from WIS TV 10 in Columbia says South Carolina OSHA has received 135 COVID-19 related complaints about problems such as:

Lack of or inadequate amount of personal protective equipment
Individuals working who had symptoms of COVID-19
Not complying with social distancing
Employers not listening to/acting on employee complaints.

Construction workers who have evidence that they became ill with COVID-19 while on the job may be able to obtain workers’ compensation benefits. How the worker can prove he or she contracted the virus at work and nowhere else during a pandemic will be the primary issue as the state considers a contested claim.

One positive development in the potential for workers’ comp claims over COVID-19 is that the South Carolina Workers’ Compensation Commission has updated its system in anticipation of COVID-19 cases. The WCC announced in a news release that it will accept two new Injury Description Table codes:

Cause of Injury Code (DN0037) – 83 for “Pandemic”
Nature of Injury Code (DN0035) – 83 for “COVID‐19”

The workers’ compensation attorneys of Joye Law Firm are actively reviewing cases from workers with COVID-19-related workers’ comp claims. If you or your loved one’s coronavirus case was truly contracted while on the job, you deserve benefits and we will fight with you to get them.

Our firm has offices in North Charleston, Myrtle Beach, Columbia, and Clinton. We also represent work injury victims throughout the state of South Carolina, including Horry County, Richland County, Laurens County, and Lexington County. Call us at 888-324-3100 or contact us online to schedule a free evaluation of your case.

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