The North Carolina Department of Health and Human Services has issued a report very critical of the nursing care provided to an Alzheimer’s patient who recently died from injuries she sustained from a fall. The report follows an extensive investigation of the nursing practices at Five Oaks Manor Nursing Home. The resident at issue is 87-year-old Annie Bell Scarboro who died from head injuries related to a fall from a loading dock off the kitchen.
The state’s report indicates that on December 18th, Scarboro managed to wheel herself in her ‘merry walker’ through three sets of unlocked doors to the outside area without the staff’s knowledge. The report also indicates there were no door alarms on any doors– including the one leading to the outside area where Scarboro died.
This incident follows similar wandering episodes Scarboro had while a resident at the facility. On May 22, 2008, managed to escape through the exact same doors she managed to navigate through prior to her death.
The state’s report into this nursing home death, concluded the facility failed to comply with 483.25(h) Accidents and Supervision, the facility failed to “ensure that the resident environment remains free from accident hazards as is possible; and each resident receives adequate supervision and assistance devices to prevent accidents.”
Among the ‘assistance devices’ ordered to be implemented at the nursing home, by state authorities is the installation of a Mag-Lock and Accutech alarm system. The Mag-Lock / Accutech system automatically locks doors as an Alzheimer’s resident approaches the area with a special bracelet that activates the system.
While a sophisticated alarm system would have prevented this nursing home death. The sad reality is that this incident should have been prevented. Had the facility followed basic safety measures for Alzheimer’s patients– staff supervision and locks on doors– there is little doubt this death could have been prevented.
Read more about this report of nursing home negligence here.
View a complete copy of the investigative report of this incident here.