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More Pennsylvania Nursing Homes Worst Offenders

More Pennsylvania Nursing Homes Worst Offenders

The recent Coronavirus outbreak has shown the importance of apt training, competent staff, and good hygiene when it comes to taking care of your loved ones in nursing homes. Even with this very serious outbreak going on, most people with family in nursing homes can’t afford to take them out and care for them at home. 

Now with tighter restrictions on family visits, it’s even more important that you trust your chosen nursing home’s management and team to keep your elders healthy and happy.

Alas, the reality is a lot of nursing facilities don’t do this. We’ve compiled a list of some of the worst offenders in Pennsylvania (according to Medicare.gov). We’re chosen to highlight these nursing homes not to scare you but to inform you about what inadequate training, incompetent leadership, and greed can mean for your loved ones. 

Though we’ve highlighted some of the worst things to happen at each nursing home, many other perhaps minor infractions caused them to get low (or no) ratings from government inspectors that we don’t describe here. We always encourage you to do your research before selecting a nursing home and continue to pay attention as policies and procedures do change. 

[Warning: contains content about abuse.]

The Gardens at West Shore - Camp Hill

Medicare.gov overall rating: N/A (too many deficiencies)

The first nursing home in our list has had too many deficiencies to get a rating from Medicare.gov. They have been designated as a “Special Focus Facility,” which Medicare.gov says it has a “history of persistent poor quality of care” and is “subjected to more frequent inspections, escalating penalties, and potential termination for Medicare and Medicaid.” For a series of major and minor violations, the Gardens at West Shore earned this ignominious designation.

One of their most egregious violations was a resident with not just a couple of bed sores, but seventeen! Bed sores are ulcers -- i.e., open wounds -- caused by a person lying in the same position for much too long. 

The pressure of the body’s bones pressing on the skin will eventually cause the skin to break down if a person is not frequently moved. Government inspectors cited The Gardens at West Shore for having a pressure wound care plan for this poor resident but not following it, resulting in the staggering and dangerous amount of painful wounds.

Corner View Nursing and Rehabilitation Center - Pittsburgh

Medicare.gov overall rating: N/A (too many deficiencies)

Corner View Nursing and Rehabilitation Center is another nursing facility with too many deficiencies to be rated. This facility has had problems with medication errors, pest control, theft of residents’ property, and more. But there was one very grave mistake of note. 

In July of 2017, maintenance workers raised the temperature of the boiler to 148 degrees in an effort to flush the plumbing system of Legionella, the bacterium that causes Legionnaires disease. The flush was performed at 1 a.m., presumably to keep from any residents from being burned by the super-hot water.

A noble attempt, but the staff failed to periodically test the water temperature after the flush. Unfortunately, that next morning an employee was washing a resident who was in a persistent vegetative state. The employee noticed the water coming out of the showerhead suddenly became very hot, so s/he shut off the water and called a nurse. However, the damage had already been done. 

The super-heated water caused serious burns on the resident’s inner and rear thighs. The resident wasn’t able to complain due to the vegetative state, so the burns were incredibly serious -- serious enough to require a massive skin graft from a corpse donor!

This horrific injury could have been prevented had maintenance had a plan to test the hot water after the flush. And after all that, government inspectors still found Legionella in the plumbing system.

Twin Lakes Rehabilitation and Healthcare Center - Greenburg

Medicare.gov overall rating: N/A (too many deficiencies)

Twin Lakes is yet another nursing facility without a rating due to too many deficiencies. You can find the “usual” problems at this facility, but there was a terrible one in mid-2018. A resident with some cognitive issues was caught entering different residents’ rooms against the rules. The nurse on duty asked what she was doing, and the resident said “touching” the other residents. Despite an admonishment, the resident kept entering other rooms.

Eventually, the nurse on duty walked in on the resident sexually assaulting another female resident, inserting a finger in the resident’s vagina. Despite this gross violation of another person’s body, the nurse did not report the incident until two days later, when an investigation was finally started.

Aristacare at Meadow Springs - Plymouth Meeting

Medicare.gov overall rating: 1 star (much below average)

Aristacare has had a litany of infractions, but one serious one resulted in the fall of a resident who had serious mental disabilities. This resident had had oxygen deprivation in the past, which resulted in cognitive disabilities requiring a ventilator and feeding tube. 

The resident also required a “posey belt,” which kept him safely secured in his geri-chair when the nursing staff wasn’t around to monitor him. However, one staff member didn’t get the memo about the belt and left the resident unsecured. The resident’s involuntary movements caused him to fall out of the chair and injure himself.

This one instance of bad communication could be viewed as a mistake, but the nursing home was also cited for not reporting the incident to regulators within 24 hours, as required by law.

Mountain View, A Nursing and Rehabilitation Center - Coal Township

Medicare.gov overall rating: 1 star (much below average)

Often the mental and physical abilities of nursing home residents can change as they age. It’s up to the nursing home to monitor changes in residents and to alter their care requirements as needed. Also, it’s important to communicate those changes to the staff doing the actual caring. 

One serious communication breakdown happened at Mountain View, where a resident’s needs for moving out of bed changed from requiring one staff member and a cane to two staff members and a cane. Physicians noted the change, but no one bothered to update the care instructions at the nursing station. You can guess what happened: a single nurse tried to move the resident, who fell and injured her wrist. Had they bothered to update the care instructions, a rather painful injury could have been avoided.

Spring Creek Rehabilitation and Nursing Center - Harrisburg

Medicare.gov overall rating: 1 star (Much Below Average)

This terrifying story of abuse comes from Spring Creek Rehabilitation and Nursing Center. According to a government report, a resident approached the licensed practical nurse (“LPN”) with tears in her eyes. She reported that two staff members had responded to a call bell from her roommate the night before. 

Her roommate was agitated and the two staff members wanted to take her to the nursing station. But instead of calming the resident down, they grabbed her by the arms and legs and ripped her from bed before placing her into her wheelchair. The resident, naturally, was terrified and cried out, begging them to stop and that she was cold and wanted to remain in bed.

The LPN told management, who then investigated and found the resident in question also corroborated the story. She even called her husband the next morning to tell him about her terrifying ordeal. They also discovered bruises and skin tears on her arms. This, along with the mental anguish caused to both residents, is considered abuse by government investigators. No mention, however, is made of what happened to the staff.

Broomall Rehabilitation and Nursing Center - Broomall

Medicare.gov overall rating: 1 star (much below average)

Many nursing homes rely on technology to keep residents with cognitive decline from leaving the facility. These devices -- typically bracelets or armbands that set off alarms when passing through an exit door -- are great tools to keep residents safe... when they work. They need to be tested and sometimes re-calibrated to make sure the technology is actually working -- something the management at Broomall Rehabilitation and Nursing Center failed to do, according to government inspectors.

Unfortunately, inspectors discovered this problem after a resident with dementia managed to leave the building. She simply stood up from dinner, walked to the elevator, then exited through a main door without any intervention from staff or an alarm going off. She didn’t get very far, but only because she tripped and fell onto her face, breaking her nose in the process. Subsequent testing of her armband showed that it didn’t activate the door alarm when passing through. Management did eventually fix the problem, but only after it was much too late for this one resident.

Willow Terrace - Philadelphia

Medicare.gov overall rating: N/A (too many deficiencies)

The last facility on this list with too many deficiencies to be rated. Willow Terrace is the site of a severe lapse in proper medication protocol for several residents back in 2018. According to government reports, over a dozen residents were affected by a bad protocol and poor training related to blood-thinning medications. 

Without going into the specifics, we’ll point out that these residents received way too much of a blood-thinner, meaning they wouldn’t clot properly and making them at a high risk of injury and in “immediate jeopardy”. Some even had to be hospitalized because of injuries that could have been prevented, or at least been less serious, had they not had dangerously thin blood.

When interviewed, most nurses and staff members didn’t know there was an upper safety limit to the blood-thinning medication. They also didn’t know that a physician had to be consulted when key clotting measurements were out of normal range. Management at Willow Terrace, fortunately, fixed the problem before any residents died, but not before many suffered needlessly.

Pennsylvania Nursing Home Abuse Lawyers

No matter their age or mental ability, nursing home residents are human beings with all the rights that come with that. Bedsores, abuse, falls, medication mishaps -- all of these things are easily prevented with good policies, proper training, and staff who care about following the rules. 

Yet as we can see here, for many nursing facilities, these basic requirements are hard to follow, resulting in severe injuries and even death. 

To learn more about what you can do about nursing home abuse and neglect, contact us. Consultations are always free, without obligation and confidential. Please contact online, by email [hidden email] or call us at 833-201-1555 to set up a time to talk. We or someone in our network will look to respond immediately. 

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Related topics: nursing home neglect (37) | substandard care (44)


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