legal resources necessary to hold negligent facilities accountable.
Hidden Lake Care Center (SFF)
Both the State of Missouri and the Centers for Medicare and Medicaid Services (CMS) conduct routine surveys, unannounced inspections and investigations on every nursing facility statewide. Their efforts help to identify serious concerns, hazardous deficiencies and violations of nursing home regulatory law. The facility must make improvements promptly to the level of care they provide.
In egregious cases, the facility might be placed on the national Medicare watch list and designated as a Special Focus Facility (SFF). This designation means that the facility will undergo many more investigations and surveys than normal. If improvements in a level of care they provide are not made promptly, or they fail to make significant changes to their policies and procedures, the nursing home could face serious financial consequences including losing their contract to provide care to Medicaid and Medicare-funded patients.
In 2017, the CMS designated Hidden Lake Care Center as a Special Focus Facility. Since the Home was added to the Federal watch list, surveyors have conducted unannounced visits to the facility many times throughout the year. Likely, the Care Center will remain on the watch list for many years. Some of the serious concerns, violations, and deficiencies involving this facility are detailed below.Hidden Lake Care Center
This facility is a ‘for profit’ 112-certified bed Long-Term Care Center providing cares and services to residents of Raytown and Jackson County, Missouri. The Home is located at:
11400 Hidden Lake Drive
Raytown, MO 64133
In addition to providing round the clock skilled nursing care, the facility also offers:
- Physical, Speech, Occupational Therapies
- IV therapy
- Restorative therapy
- Tube feeding
- Advanced wound care
- Pain management
- Respiratory services
- Diabetic management
- Hospice services
Federal and state nursing home regulators are authorized to impose monetary penalties on any nursing facility in Missouri identified with deficiencies and violations that harmed or could have harmed the home’s residents. These fines are meant to alert the facility that corrections must be made immediately to avoid additional penalties.
In the last three years, Hidden Lake Care Center has received over $30,000 in monetary fines. This includes an $18,200 fine on 11/06/2015, a $3,381 fine on 03/09/2016, and a $11,669 fine on 10/26/2016. Additionally, Medicare denied the facility’s request for payment on two occasions due to substandard care. These payment denials occurred on March 9, 2016, and on October 26, 2016. During the same time, the Missouri State agency in charge of nursing home regulations received fourteen formally filed complaints that after investigations resulted in citations.Current Nursing Home Resident Safety Concerns
The state of Missouri and CMS routinely update their long-term care home database system to reflect all health violations, opened investigations, safety concerns, incident inquiries, dangerous hazards, and filed complaints. This publicly available information can be found on numerous sites including Medicare.gov. Many families use this information to make well-informed decisions on where to place a loved one who requires the highest level of skilled nursing care and hygiene assistance.
Currently, Hidden Lake Care Center maintains an overall two out of five stars compared to all nursing homes in the United States. This ranking includes one out of five stars for health inspections, four out of five stars for staffing issues, and two stars out of five stars for quality measures. Some violations, deficiencies and safety concerns involving this facility include:
- Failure to Report and Investigate Any Act or Allegation of Abuse, Neglect or Mistreatment of Residents
- Failure of the Staff to Maintain a Resident’s Dignity and Respect of Individuality
- Failure to Ensure At Least One Staff Member Trained in CPR Was Present during Every Shift
- Failure to Develop, Implement and Enforce Programs That Investigate, Control or Keep Infections from Spreading
- Failure to Ensure That Residents Receive Proper Treatment to Prevent the Development of a Bedsore or Allow Existing Bedsore to Heal
- Failure to Ensure the Nursing Home Is Free from Accident Hazards
In a summary statement of deficiencies dated October 26, 2016, the state investigator noted the facility’s failure to “follow their policy to investigate and report to the State Agency and elbow fracture of unknown origin for [a resident].” The state investigator conducted an interview with the facility’s Certified Nursing Assistant (CNA) who said “the resident had [their] arm in a brace months ago but was unsure what happened to the resident.”
The surveyor interviewed the facility’s Assistant Director of Nursing who stated that they “could not locate the investigation for the resident’s elbow fracture but was still trying to locate the investigation.” The surveyors interviewed the Medical Director and Nurse Practitioner who stated that they “expected staff to follow the Abuse and Neglect Policy for investigating any potential injuries and… expected an investigation to be completed per the facility policy and the State Agency notified.”
Surveyors interviewed the facility’s Registered Nurse (RN) who stated that “all potential injuries should have been immediately reported; after the potential injury is reported, the nurse is to have assessed the resident, notify the physician and complete an incident report and report the potential injury to the State Agency.”
In a summary statement of deficiencies dated October 26, 2016, the state investigator noted the facility’s failure to “promote dignity and respect for one supplemental resident by trying to force the resident into the shower room.” An observation was made of the resident on the morning of October 24, 2016, which showed that the resident “was in their wheelchair outside the open shower room door and a Certified Nurses Aide (CNA) was trying to wield the resident into the shower room. The resident was yelling ‘Im not taking a shower today; I don’t want to shower today, I’m not going into that damn place, somebody help me, I’m calling the police.”
“The resident placed [their] feet from the on the ground while [the Certified Nursing Aide] Trying to wield the resident forwarded to the shower room.” The CNA stated to “the resident ‘we need to get that brief off you’ in a normal tone of voice and [their] voice was not escalated… [and] tried to tilt the wheelchair up from the back to attempt to lift the resident’s firmly place feet off the floor but was unsuccessful.”
In a summary statement of deficiencies dated March 31, 2016, the state investigator noted the facility’s failure to “ensure there was at least one staff member who was cardiopulmonary resuscitation (CPR) certified on each shift.” This deficiency by the nursing staff had the potential to affect “all residents in the East and West building.”
The state investigator interview the facility’s Assistant Director of Nursing who stated that “the facility had never been asked for a list of staff who were CPR-certified until now.” A review of the facility’s List of CPR Certify Staff revealed that the facility “had two staff members who were CPR certified” and that the facility “did not have CPR-Certified staff working on every shift, and did not have an Assistant Director of Nursing who was CPR certified.”
During an interview with the Assistant Director of Nursing was revealed that “staff was responsible for obtaining their CPR certification on their own, and that the facility did not pay for classes, and the facility did not provide an opportunity for staff at the facility to become CPR certified.”
In a summary statement of deficiencies dated March 31, 2016, the state investigator noted the facility’s failure to “ensure infection control practices were followed to prevent cross-contamination for [a resident] by not changing [their] dressing to [their] right lower extremity wound when the dressing was wet.” During the investigation, it was found that the staff had not performed fingernail care to the resident’s fingernails that “were visibly soil with a dark brown substance on top and underneath the fingernails.”
The facility was reminded of their January 1, 2014, Nail Care Policy that read in part “the purpose was to clean the nailbed, keep nails trimmed, prevent infections, accidental skin injuries and ensure residents appear clean and well-groomed.” However, “the proper procedure on how to provide nail care was outlined, but it did not direct how often the task was to be performed.”
In a summary statement of deficiencies dated March 9, 2016, the state investigator noted the facility had failed to “follow physician’s orders to treat pressure ulcers for [three residents].” The state investigator reviewed a resident’s Active Medical Record that showed “no Care Plan to instruct staff on resident’s care needs, including [their] pressure sore.”
The state investigator interviewed the facility’s Director of Nursing on the morning of March 18, 2016, along with the Assistant Director of Nursing. The Directors stated that “they expect that the [staff] transcribes the physician’s orders accurately into the Medication Administration Record and Treatment Administration Record, and then complete the resident’s wound care per the physician’s orders and document it properly. If the Medication Administration Record and Treatment Administration Record is not initiated, then it is not completed.”
In a separate summary statement of deficiencies dated April 30, 2016, the state investigator noted that the facility had failed to “identify, assess and treat a newly developed [sore].” A review of the resident’s Minimum Data Set (MDS) dated February 18, 2016, revealed in part that the resident is “at risk for skin breakdown; did not have any pressure ulcers, venous wounds or arterial wound ulcers.”
A review of the resident’s Wound Care Plan, dated February 18, 2016, revealed that “there were no updates when the wounds to the left great toe, left heel, and right heel were discovered.” The surveyor also noted that “there were no updates after the left medial (inside) foot by the great toe (bunion area) that was discovered by the surveyor.”
In a separate summary statement of deficiencies dated October 26, 2016, the state investigator noted the facility’s failure “to complete pressure ulcer measurements, and tracking, [and] provide the downgrading and staging of the pressure ulcer.” The staff also failed to “provide appropriate treatment, complete weekly skin assessments, and put preventative measures in place for pressure ulcers for [one resident].”
The deficiency by the nursing staff “resulted in the development of two facility-acquired unstageable pressure ulcers and one facility-acquired Suspected Deep Tissue Injury, and two complete skin assessments and wound tracking, to properly assess, identify, stage, and document a pressure ulcer for [two residents].”
In a summary statement of deficiencies dated March 9, 2016, the state surveyor identified a deficiency. The surveyor noted the facility’s failure “to provide a stable, sturdy, and safe handrail assist device for [one resident] to use to stabilize [the resident] while using the toilet and to assist with transfers to and from the toilet.”
Surveyors observed a resident’s bathroom with the Director of Nursing, the Assistant Director of Nursing and a Maintenance Supervisor. The Staff was “showed an assist device attached to the toilet that had a rail on each side and thin legs on each side of the toilet that went to the floor, giving the appearance of a toilet being a chair with arms. The device was made of aluminum. The legs were movable and moved back and forth with ease, and were extremely unsteady, and when force was placed on it during the transfer, the legs on the assist device would easily move and could possibly break off.”
After the observation, the surveyor interviewed the Director, Assistant, and Maintenance Supervisor who said that “the device was not stable or sturdy, not adequate for someone of the resident’s weight and size, and they would remove it immediately. They were unable to put a handrail on the wall in the bathroom because there were no studs in the center of the wall to ensure a handrail would be stable and sturdy.” It was noted that the Director “was easily able to pull half the device from the toilet without tools.”
In a separate summary statement of deficiency dated October 26, 2016, the state investigator noted the facility’s failure “to complete fall investigations, fall risk assessments, neural checks and put interventions in place for one cognitively impaired [resident] who fell three times including a fall with the fracture.” In a separate incident, another resident “fell two times including a fall with a hip fracture.”
The state investigator noted that the facility failed to “ensure a safe transfer for [one resident] and did not complete an Administrative Investigation or put interventions in place after a potential injury during repositioning for [another resident].”
In a third summary statement of deficiencies dated October 10, 2017, the state investigator noted that the facility failed to ensure “staff transferred residents in a safe manner to prevent the possibility of injury.” This failure was identified “when staff lifted and moved two [residents] with the [support] legs of the mechanical lift in the closed position. Staff did not repair a broken window ledge that had ragged, sharp edges and which staff placed [the resident’s] bed up again. Staff did not assure they knew the whereabouts [of another resident] for approximately seven hours.”
In the incident involving potential elopement, a Certified Nursing Assistant stated during an interview that the resident “was in the facility earlier at breakfast but [they] had not seen the resident since then.” Another CNA stated that the resident “was not in [their room but they] probably went to Wal-mart and [they] would have signed out at the nurse’s station.” However, a review of the facility’s Sign Sheet on that date revealed: “no documentation of the resident signed out…”
If you suspect your loved one was the victim of abuse, mistreatment or neglect while a patient at Hidden Lake Care Center, or any other nursing facility, contacting a personal injury attorney could be a wise decision. Providing legal assistance and representation, your attorney can handle every aspect of your case from filing a claim and investigating the incident to presenting evidence in front of a judge or claims adjuster.
No upfront payments are necessary because personal injury attorneys accept all nursing home abuse claims for compensation and wrongful death lawsuits through contingency fee agreements. This arrangement provides immediate legal counsel and representation, and your attorney fees are not paid until the law firm successfully resolves your case through a jury trial or negotiated out of court settlement.