The decision to turn over the provision of care to a loved one to professional staff in a nursing facility is never easy. In some situations, the nursing facility staff will both fully assure the family that they follow established standards of care, procedures, and protocols when that does not happen. It is often months before the family observes any form of mistreatment that arises from a lack of enough staff, mismanagement, or poor hiring practices that employ abusive caregivers.
If you were misled by a Logan County nursing home, staff, employees or other residents, and your loved one was victimized, contact the Colorado Nursing Home Law Center attorneys for immediate legal intervention. Our team of Colorado nursing home lawyers has successfully resolved cases like yours, and we can help your family too. Let us use the law to hold those responsible for causing your loved one harm both legally and financially accountable.
This Medicare/Medicaid-participating center is an 84-certified bed facility providing services to residents of Sterling and Logan County, Colorado. The "for profit" long-term care (LTC) home is located at:
1330 North Sidney Avenue
Sterling, Colorado, 80751
(970) 522-4888
In addition to providing around-the-clock skilled nursing care, Devonshire Acres Senior Living Community offers other services that include:
The investigators for the state of Colorado and federal nursing home regulatory agencies have the legal responsibility of penalizing any facility that has violated rules and regulations that harmed or could have harmed a resident. These penalties often include monetary fines and denying payment of Medicare services. Typically, the higher the penalty, the more egregious the problem.
Within the last three years, Devonshire Acres Nursing Center has received ten formally filed complaints due to substandard care that all resulted in citations. Additional information concerning penalties and fines can be reviewed on the Colorado Department Of Public Health an Environment Department of Public Health Website about this nursing facility.
Detailed information on every long-term care facility in the state can be obtained on government-run websites including the Colorado Department of Public Health site and Medicare.gov. These regulatory agencies routinely update their list of health violations, safety concerns, incident inquiries, opened investigations, filed complaints, and dangerous hazards on nursing homes statewide.
According to Medicare, this facility maintains an overall rating of one out of five stars, including two out of five stars concerning health inspections, one out of five stars for staffing issues and four out of five stars for quality measures. The Logan County neglect attorneys at Nursing Home Law Center have found serious deficiencies and safety concerns at Devonshire Acres Nursing Center that include:
In a summary statement of deficiencies dated March 28, 2017, the state investigators documented the facility had failed to “ensure that the resident environment remains as free from accident hazards as is possible for [two of five residents].” The investigator said that “specifically, the facility failed to provide indicators for staff to distinguish between similar resident’s names and residents residing in the same hallway.”
The investigative team reviewed residents with similar nicknames residing in rooms “on the same hallway. They had the same last name, and first initial [and the] abbreviation of their names were the same letters. The staff called the residents by nicknames with a one-letter difference. The resident’s share the same nursing staff, medication cart, and medical records storage.”
The investigators said that “the medical records contain picture identification of each resident along with their names and birthdates. The records did not contain the name alert system to let staff, not familiar with the residents know about the similar names.”
On the morning of March 22, 2017, the surveyors “requested a staff member, in the dining room, to locate [a resident]. The staff member reported to [another resident] who had a similar nickname as [the first resident].” The surveyors said that “the staff member was not able to differentiate between the similarities of both nicknames.”
The investigators interviewed a Licensed Practical Nurse (LPN) that afternoon who said “there is nothing to alert us about similar names. I am just diligent. They do not look alike, so we do not get them mixed up.”
The Certified Nursing Assistant (CNA) said during an interview that the first resident “was scheduled for a shower after she moved to the unit a couple of months ago, but [the CNA] had given the shower to [the other resident] instead. She said there were no systems to alert the staff of similar names.”
During an interview with the facility Director of Nursing, it was revealed that “we do not have a process in place to alert staff of similar names. I am not aware that we need anything because we do not have any issues. New staff gets a 30-day orientation before they are on the floor, so they are trained in resident needs. These are two very different residents and the staff have not confused them. The contracted therapy staff is also familiar with the residents.”
In a separate summary statement of deficiencies dated April 26, 2018, the state investigator stated the “facility failed to reassess two residents [after] fall to determine the root cause of falls and revise the Care Plan interventions to prevent further falls.”
The surveyor stated that “specifically, the facility failed to reassess [two residents’] fall risk after a fall and implement interventions to reduce injury from falls and to prevent further falls.” The survey team reviewed a resident’s Fall Record that according to a Skilled Daily Nurses’ Note, “the resident was very restless and put himself on the floor at 1:30 AM. According to the incident report for this fall, the staff reported that the resident sat up in bed and slid off the bed onto the floor mat next to the bed.”
The Morning Meeting Notes revealed that the “resident’s fall was discussed. The resident had a low bed and a mat. A concave mattress would be added to define the edges of the bed. The Care Plan was updated with the date and time of the fall, but the new intervention was not added to the Care Plan.”
Documentation of a second fall was recorded in an incident report where the resident “was found lying on the mat next to the bed. The bed was in the lowest position. Telephone orders were obtained [for a] concave mattress with soft Posey rails to the bed to define the bed margins. A nurse alarm and bed sensor may be used if Posey rails were unsuccessful. The Care Plan was updated with the date and time of the fall, but the new interventions were not added.”
A third fall was noted in the Skilled Daily Nurse’s Note showing that staff “entered the resident’s room and observed him lying on the floor next to the bed on a crash mat. The resident stated he slipped out of bed. According to the incident report for this fall, staff entered the room and observed him lying on the floor next to the bed on the crash pad. The Care Plan was updated with the date and time of the fall, but no new interventions were put into place.
A fourth fall was noted in the Skilled Daily Nurse’s Note documented by a CNA who “went into the resident’s room and observed a resident with his head on the bed and his knees on the mat beside the bed. The incident report for this fall repeated the same as above. The Care Plan was updated with the date and time of the fall, but no new interventions were put into place.”
A fifth fall was also documented where the resident “rolled his knees on the floor mat with the rest of his body lying on the bed. He had a bruise on the top of his right toe. He had an abrasion to the left knee from the previous fall. He had urinated on the floor and the bed. His ‘pull up’ was wet.”
In a summary statement of deficiencies dated March 28, 2017, a state investigator noted the nursing home's failure to “maintain an infection control program designed to provide a safe, sanitary and comfortable environment and help prevent the development and transmission of disease and infection.”
The investigator said that “specifically, the facility failed to sanitize the mechanical lift between resident use and ensure proper [measured] time for a disinfectant.” The state surveyors performed a continuous observation on March 24, 2017 beginning at 8:54 AM through 9:15 AM.” During that time, two Certified Nursing Assistants (CNAs) were observed entering a resident’s room “with a mechanical lift. They did not sanitize the lift before use.”
During that time, both CNAs “donned gloves and secured the resident’s sling to the lift. Using the lift, they transferred the resident from the wheelchair to the bed. The resident was observed touching the handlebar of the lift. They did not sanitize the lift after use.”
In a summary statement of deficiencies dated June 7, 2018, the state investigators noted that “the facility failed to ensure residents had access to the facility’s contract hospital provider [by] the resident or their representative’s choice.” The deficient practice by the nursing staff involved three residents “reviewed for hospice care.”
The investigative team stated that specifically, “the facility failed to provide timely access to hospital end-of-life services [for two residents] per their representative’s request.”
In one incident, an 80-year-old resident MDS (Minimum Data Set) revealed “he had severe cognitive impairment,” and he had “a life expectancy of less than six months. The MDS Assessment indicated “he was not receiving hospice services as a resident and his representative was not receiving hospice respite.”
During an interview with the resident’s representative and staff, it was revealed that the resident “was very sick. She said the facility knew he was terminal due to the hospital documentation they received which contained a hospital discharge Physician’s notes, and because she and the resident told the facility he was terminal.”
The resident’s representative stated that “she asked the Nursing Home Administrator about getting hospice services for [the resident] and she told her hospice services were not available at the facility. She said the Nursing Home Administrator told her that hospice services were not allowed in the facility.”
The representative said that “the facility did not inform her [before] admission that they would not provide hospice services. He said she told the nursing staff and the Nursing Home Administrator that [the resident] deserve a better end of life care.”
The representative said that the facility did not attempt to “hold a care conference with him or her to coordinate hospice care for him nor to provide her with information explaining the type of Comfort Care they were provided for him.”
The resident’s representative said that “she continually expressed concerns about the quality of his end-of-life care and the lack of hospice services for him to the nurses and the Nursing Home Administrator.” The representative said that “the facility did nothing about her concerns.” She says that the resident “expired in the facility without receiving hospice services.”
The survey team interviewed the Hospice Social Worker who stated that the resident’s “representative revealed to her she was dissatisfied with the end-of-life care the facility was providing [the resident].” The Social Worker said that “his representative revealed the facility was lacking in the type and amount of support she and [the resident] needed for his end-of-life care.”
The Hospice Office Manager was interviewed and stated that “they had a long-standing hospice contract with the facility. She said there had been countless referrals from nearby hospitals (per family requests) for residents, who were to be admitted to the facility, to receive hospice services upon hospital discharge.”
The Hospice Office Manager said “none of the facility’s residents admitted from these hospitals had been referred to receive hospice services by the facility. She said the family representative of [the resident] had requested hospice services and the facility did not contact hospice on behalf of the resident and the family to initiate hospice care.”
Do you suspect that your loved one was neglected or abused while living at Devonshire Acres Nursing Center? If so, contact the Colorado nursing home abuse lawyers at Nursing Home Law Center at (800) 926-7565 today. Our network of attorneys fights aggressively on behalf of Logan County victims of mistreatment living in long-term facilities including nursing homes in Sterling. Contact us now to schedule a free case review to discuss how to obtain justice and resolve a financial compensation claim.
Our nursing home abuse attorneys can represent your loved one injured by the inappropriate actions of the facility and staff. Our network of attorneys will work on your behalf to ensure your family receives sufficient financial compensation to recover your damages. We accept every case involving nursing home neglect, wrongful death, or personal injury through a contingency fee arrangement. This agreement will postpone payment of our legal services until after our lawyers have resolved your case through a negotiated settlement or jury trial award.
Our network of attorneys offers every client a “No Win/No-Fee” Guarantee, meaning if we are unable to resolve your case successfully, you owe us nothing. Let our network of attorneys start working on your case today to ensure your family receives the financial compensation they deserve for your harm. All information you share with our law offices will remain confidential.
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