Publicly available information helps families determine where to place a loved one who requires the highest level of nursing care and assistance with hygiene and activities of daily living. Both the State of Connecticut and the Centers for Medicare and Medicaid Services (CMS) conduct routine unannounced inspections, investigations, and surveys of every nursing facility statewide. Their efforts help to identify serious deficiencies, violations and safety concerns.
Surveyors will expose some deficiencies during inspections that needs correcting at the nursing home. However, facilities identify with egregious violations often must comply with regulatory standards on policies, procedures and the level of care they provide every resident. If the facility is unable to make necessary corrections, the federal and state nursing home regulatory agencies will add the nursing home to the federal Medicare watch list and designate the Center as a Special Focus Facility (SFF). This designation brings with it profound financial consequences if changes are not made promptly.
In early 2017, the CMS and the state of Connecticut designated RegalCare at Greenwich a Special Focus Facility. The nursing home was then added to the watch list due to substandard levels of care provided to the residents. Some violations were egregious and harmed or could have harmed patients under the facility’s care. The nursing home will likely remain on the watch list for years as surveyors and investigators assess and evaluate the improvements the facility makes to ensure the changes are permanent. Some violations and deficiencies that keep the Home on the watch list are detailed below.
This Long-Term Care Center is a ‘for profit’ 75-certified bed Home providing cares to residents of Greenwich and Fairfield County, Connecticut. The Facility is located at:
1188 King Street
Greenwich, CT 06831
(203) 531-8300
In addition to providing skilled nursing care, the facility also offers short-term rehabilitation and an amputee rehabilitation program.
Both the state and federal nursing home regulatory agencies are authorized to impose monetary penalties on any nursing facility identified with serious deficiencies. These fines are issued to discourage continuing substandard care so that administrators and nursing staff will take proactive measures to eliminate serious hazards or poor service.
Over the last three years, RegalCare at Greenwich received three separate fines including a $1625 fine on 12/03/2014, a $293 fine on March 31, 2015, and a $760 fine on April 12, 2017. Also, within the same time frame, there were five formally filed complaints and four facility-reported issues that all resulted in citations.
The state of Connecticut and the CMS routinely update their long-term care home database systems to reflect all incident inquiries, safety concerns, health violations, dangerous hazards, filed complaints, and opened investigations. This information can be found on numerous sites including Medicare.gov.
Currently, RegalCare at Greenwich 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 four stars for quality measures. Some major concerns involving violations, deficiencies and hazards are listed below.
In a summary statement of deficiencies dated April 12, 2017, the state investigator noted the facility’s failure “to conduct a thorough investigation” involving a “cognitively impaired resident.” A review of the resident’s Care Plan dated December 9, 2016 “identified the resident ambulates independently, with a walker. Interventions directed to encourage socialization with peers.”
The state investigator reviewed the resident’s Nurses Notes from January 16, 2017, through January 22, 2017 [which] identified that the resident complained of left-sided pain on-and-off and was medicated with Tylenol. The resident’s appetite and fluid intakes declined. The physician was notified, and orders included blood work, left rib x-ray, chest x-ray, and intravenous fluids, which the resident subsequently pulled out or refused.”
Documents reveal that “on January 23, 2017, the resident was in excruciating pain, Tylenol was administered, a left hip x-ray was ordered… and the physician ordered [medications to be administered] every six hours as needed for pain which was administered with some effect.” However, later that morning the resident was noted to be continually complaining “of pain and that the pending left hip x-ray was to be done as soon as possible.”
At 6:00 that evening, the Nurses Notes revealed that the resident was suffering from “an acute medical condition to the left ribs. The physician [then] directed the facility’s staff “to transfer the resident to the hospital.”
The investigator reviewed the resident’s clinical records and Reportable Event dated January 23, 2017, with the facility Director of Nursing Services on April 12, 2017.” The Director “identified the resident was complaining of rib pain for days, but that the resident continued to function normally and was ambulating until when the resident refused to get out of bed.”
The Director stated that the doctor “went to see the resident and there were no new orders but [they were] unable to provide documentation to reflect the medical doctor’s visit. The Director of Nursing Services identified that the facility policy is to thoroughly investigate the incident, that the resident had no bruising, swelling or indication of a fracture and there was nothing identified that the resident fell or that someone did something.”
The Director stated that they were told about the resident after asking that the resident “was walking normally and that [the resident] continued to talk the staff even after the resident went to the hospital. The Director of Nursing Services identified that although [the facilty] had only had two written statements [from a Licensed Practical Nurse and another staff member, that the facility] had taken verbal statements on the phone and had written down the results.
Even so, the Director was “unable to identify why the additional statements that were taken verbally were not in the investigation, and after searching for the information was unable to find any further statements, but [the facility] stated that [they] knew that all of the staff or spoken to.”
In a summary statement of deficiencies dated April 12, 2017, the state investigator noted the nursing staff “applied a ‘wander guard’ to prevent an alert, oriented, and self-responsible resident from going outside without conducting an interdisciplinary assessment for the use of the device as a restraint.” The documentation revealed that when the resident was admitted to the facility on September 22, 2016 “no elopement assessment was available in the clinical record at the time of admission.”
The resident’s Interim Care Plan dated November 2, 2016, “identified the resident was observed in the back of the building emptying trash [and] intends to wander. Interventions include educating the resident that staff is available to help as needed, apply ‘wander guard’ bracelet to the resident, and to check function every month and placement every shift.”
However, the resident’s Quarterly MDS (Minimum Data Set) “identified the resident was without significant cognitive impairment, had no problem behaviors, did not wander, and was independent for all activities of daily living.” There was a written statement in the resident’s documents that indicated that the resident “eloped [wandered away] from the facility the evening of January 3, 2017.” Even so, a review of the resident’s risk nursing Notes and social service Notes “failed to provide documentation of the resident being absent from the facility without notification (missing resident).”
The state surveyor asked for a “Reportable Event Form of the incident on January 3, 2017” and was provided the “required Reportable Event Form that indicated that the resident went out on a pass without notified staff noted at 7:15 PM.” A handwritten note “on the bottom of the form was that the resident returned and stated [they] went out to visit a friend. The form indicated that the resident was educated to sign out with staff prior to leaving the facility. No time of return was noted on the form.” A subsequent “psychiatric evaluation [was conducted] on January 4, 2017 [that] noted the resident was competent for independent leave of absence…”
The Director of Nursing Services “was unable to provide any assessments for the need for a ‘wander guard’ for an alert and oriented, self-responsible resident.”
In a summary statement of deficiencies dated October 6, 2016, the state investigator noted the facility’s failure “to provide social service intervention to ensure the resident [without cognitive deficits] was provided with appropriate clothing.”
An observation was made of the resident at noon on October 3, 2016, who “was changed into [a hospital gown] after receiving morning care.” An interview with the resident revealed that at that time they were “waiting for a friend to drop off [their] clothes. Subsequent periodic observations on October 4, 2016, and October 5, 2016, throughout the day noted that [the resident] continued to be wearing [a hospital gown].”
The state investigator interviewed the facility’s Director of Social Work and reviewed clinical records. It was revealed that the Director was “aware that [the resident] had no clothes to where since admission [on August 23, 2016 – six weeks earlier, but the Director] did not follow-up with the resident’s friend to acquire appropriate clothing for the resident to wear.”
In a summary statement of deficiencies dated April 12, 2017, the state investigator noted the facility’s failure “to ensure the resident was treated in a dignified manner.” This investigation was in response to a review of a resident’s Reportable Event dated December 28, 2016.” The report identified the resident had “reported that on December 27, 2016, at 7:30 PM [they were] handled roughly by [a Nursing Assistant who had] spoken to [the resident] in a loud tone.”
In response to the incident, the facility “immediately suspended [the Nursing Assistant] and initiated an investigation. The facility at that time substantiated the allegation of abuse, and [the Nursing Assistant] was terminated from employment.”
The surveyor noted that the clinical record including the resident’s Care Plan, Social Service Notes, and Nurses Notes “failed to reflect any documentation of [the resident’s] allegation of abuse on December 27, 2016.” The multiple attempts of the surveyor to reach the resident “were unsuccessful.”
The state surveyor interviewed the facility’s Director Nursing Services on the afternoon of April 11, 2017.” The Director “identified that although initially, the facility substantiated the allegation of abuse, additional interviews were conducted with [the resident, who] maintain that the incident did not involve [them].” The resident claimed that it “was between two staff members in the room, and not that [the Nursing Assistant] was only rude to [the Licensed Practical Nurse].”
The Director or of Nursing Services “identified that staff should not be arguing with each other while providing care to the resident.” The Nursing Assistant “was returned to work.” Even though the Nursing Assistant “was provided with re-education after the incident on December 27, 2016, the [Director] was unable to provide documentation to reflect re-education was provided to [the Licensed Practical Nurse who] participated in the altercation and the resident’s room.”
In a summary statement of deficiencies dated April 12, 2017, the state investigator noted multiple failures by the facility’s administration and nursing staff. These deficiencies include:
- The facility’s “failure to identify unsafe smoking practices and provide appropriate supervision and smoking and completely complete quarterly assessments/smoking agreements per facility policy.”
- The facility’s failure “to ensure adequate supervision to prevent a fall with injury, and failed to review and revise the Plan of Care after multiple falls resulting in a fall with an injury.”
- The facility’s failure “to ensure that their missing resident procedures were initiated when [a resident] was found missing from the facility without notice.”
In a summary statement of deficiencies dated October 6, 2016, the state surveyor noted the facility’s failure “to complete a thorough skin assessment upon admission and obtain treatment orders to treat a pressure ulcer.” The investigator reviewed the resident’s Nursing Omission Assessment that identified “hairline stage II opening located in the coccyx. The clinical record failed to reflect that an assessment of the hairline Stage II pressure area was documented.”
In a summary statement of deficiencies dated October 6, 2016, the state investigator noted the facility’s failure “to assess a decline in bladder function or attempt to restore continence.” This deficiency involved a resident with a moderate cognitive impairment who “requires extensive assist for toileting and personal hygiene, and [requires] limited assist for locomotion on-and-off the unit.”
The resident’s Care Plan dated August 16, 2016 “identified a problem of bladder incontinence related to dementia. No interventions were noted on the resident’s Care Plan.” The surveyor interviewed the facility Licensed Practical Nurse (LPN) in the early hours of October 6, 2016, who indicated that they knew the resident “was continent because [they had seen the resident] going to the bathroom.”
The LPN was asked if the resident “was ever incontinent.” The LPN responded that they “did not know because [they] do not provide care to the resident [but] indicated that the resident wears briefs and is probably incontinent at night.” The LPN stated that they would have asked the Nursing Assistant “if the resident was incontinent and also directed [the surveyor] to look at the Nursing Assistant Flowsheet.”
When asked if they were aware if the resident “had a specific Plan of Care regarding her bladder function,” the Licensed Practical Nurse stated that they “did not know of any specific Care Plan regarding urinary continence for this resident.” It was documented by the surveyor that the “facility did not initiate a bladder retraining program for [the resident] when a significant decline in function was noted in the Quarterly Minimum Data Set report.
If you believe your loved one was mistreated, neglected or abused as a patient at RegalCare at Greenwich, to contact a personal injury attorney could be a wise decision. A lawyer working on your behalf can build a case for compensation, file all the necessary paperwork, negotiate a settlement, or present evidence in front of a judge and jury.
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 representation, advice, and counsel while postponing payment of attorneys fees until the case is successfully resolved. If the law firm is unable to secure monetary recovery, the client owes the lawyer nothing.
Attorney Nicholas E. Wocl
Licensed in Connecticut
Chicago Nursing Home Injury Lawyer Nursing Home Law Center LLC Home