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Citation history
Health deficiencies cited at Alice Hyde Medical Center during CMS and state inspections, most recent first.
The facility failed to protect residents from abuse by not adequately updating and implementing behavior care plans and 15‑minute safety checks for residents with known sexually inappropriate and aggressive behaviors. One resident with dementia and Parkinson’s disease had a long history of sexually inappropriate comments, gestures, and physical contact toward staff and intrusive wandering into others’ rooms, yet their care plan was not consistently revised to add interventions to reduce these behaviors or protect others. This resident was later found in bed with another cognitively impaired resident, partially undressed, while the other resident was crying and unable to explain what happened. In a separate case, a resident with Alzheimer’s disease and documented wandering and physically and verbally abusive behaviors was placed on 15‑minute checks after multiple altercations, but staff did not perform or document these checks during a meal period and later found the resident wandering into another resident’s room, demonstrating a failure to carry out required monitoring.
A resident with Parkinson’s disease, dementia, and known behavioral issues was sent to a hospital after being found in another resident’s room and had a care plan including 1:1 interventions and 15‑minute checks. After the transfer, the MD and SW informed the family that the facility could no longer meet the resident’s needs and would discharge the resident, directing the family to the hospital SW for alternative placement and discussing packing belongings and benefit redirection. The DON stated the resident required a locked unit due to exit‑seeking, that 15‑minute checks had failed, and that the facility chose not to readmit the resident while its investigation was ongoing. The family reported they were told the resident would not be accepted back, were not met with regarding discharge, and were not given alternative placement options, and the resident was instead sent to another hospital unit used to hold behaviorally complex residents while awaiting nursing home placement.
Three residents with cognitive and physical impairments experienced falls after staff failed to follow care plans, including not providing scheduled toileting, not using required two-person transfers, and not activating a bed alarm. These lapses in care led directly to resident injuries.
A nurse administered seven medications to a resident that were prescribed for another individual, failing to verify the resident's identity and not following the required medication administration protocols. The resident, who had dementia and severe cognitive impairment but could usually state their name, received the wrong medications due to the nurse's failure to perform the five rights of medication administration.
A resident with severe cognitive impairment and Alzheimer's was left unattended and fell, despite requiring staff assistance for ambulation. The incident was not reported to the Department of Health until the following day, violating facility policy and state regulations.
The facility failed to implement comprehensive care plans for five residents, resulting in unwitnessed falls and minor injuries due to missed 15-minute safety checks, improper bed positioning, and missing bed alarms.
A resident with multiple diagnoses was found on the floor with the bed not in a low position, the call light not within reach, and without socks on. The CNA responsible did not follow the care plan, which included a low bed and appropriate footwear. The CNA received education on following care plans after the incident.
Failure to Protect Residents From Sexual Abuse and to Implement 15-Minute Safety Checks
Penalty
Summary
The deficiency involves the facility’s failure to protect residents from abuse, specifically sexual abuse and resident-to-resident aggression, and to implement and follow behavior care plans and safety interventions such as 15‑minute checks. One resident with Alzheimer’s disease, paralysis on one side, and aphasia had a care plan noting combative and resistant behaviors, weepiness, and attempts to self‑transfer, with goals that they would not be a victim or aggressor and interventions to monitor behaviors and escalations. Another resident with Parkinson’s disease, dementia with anxiety, and heart disease had a behavior care plan documenting a tendency to be sexually inappropriate, to wander, and to stay awake at night. The care plan for this resident initially focused on inviting them to activities, assessing for behaviors, and monitoring cognitive status, and was later updated to include diversion, 1:1 supervision, television, and 15‑minute checks. Despite this, between two specified dates there were 26 nursing notes documenting this resident’s sexually inappropriate comments, gestures, propositions, and physical contact with staff, including grabbing a staff member’s breast, without corresponding updates to the behavior care plan to add interventions to reduce sexually inappropriate behaviors or to protect other residents and staff. Physician notes over time documented that the sexually inappropriate behaviors continued daily, with staff reporting increased sexually inappropriate comments and attempts at touching staff. The notes described multiple medication adjustments in response to ongoing sexual disinhibition, agitation, anxiety, hallucinations, and mood swings, and family concerns about the resident’s behavior. A prior incident was documented in which this resident was found in another resident’s room, in their wheelchair next to the sleeping resident’s bed, appearing to watch them sleep, and insisting that the sleeping resident was their spouse. Subsequent nursing documentation described the resident intrusively wandering into other rooms, stating other residents were their spouse, asking staff if they were married, and being difficult to redirect. Staff interviews indicated that 15‑minute checks were used for behaviors and resident‑to‑resident altercations, that all nursing staff were responsible for performing these checks, and that there was little or no specific training on managing sexually inappropriate resident behaviors beyond general dementia training and diversion tactics. The deficiency culminated in an incident where the cognitively impaired resident with Alzheimer’s disease was found in their room with the sexually disinhibited resident. A family member entered the room and found the second resident lying on their side in the first resident’s bed with their pants and brief pulled down to their knees, while the first resident was in a t‑shirt and intact brief, with their left breast exposed according to witness statements. The first resident was crying and shaking and unable to communicate what had happened due to dementia. Facility documentation and hospital records indicated no penetration and no immediate physical injury, though later notes described small bruises on the resident’s leg and thigh of uncertain origin. Observation sheets showed that the sexually disinhibited resident was documented as being in their own room on 15‑minute checks during the time of the incident, despite being found in another resident’s bed. Interviews with the DON and other staff acknowledged that 15‑minute checks had failed to prevent the resident from entering other residents’ rooms and that staff were not able to keep residents safe under the existing interventions. A separate but related deficiency involved another resident with Alzheimer’s disease, major depressive disorder, and severe cognitive impairment, who had a behavior care plan documenting wandering, verbally and physically abusive behavior, intrusive wandering, exit‑seeking, and aggressive behaviors such as kicking, hitting, abusive language, threatening behavior, resisting care, and striking or shoving other residents. The care plan included diversion activities and repeated use of 15‑minute checks after multiple incidents, including unsafe wandering, striking a resident on the head, shoving a resident to the floor, kicking a resident, and hitting a resident in the chest and face. On one date, a care plan note documented that this resident was agitated, pushed a staff member, could not be redirected or calmed, and was given intramuscular Haldol and placed on 15‑minute checks. However, on a later date, surveyor observations and record review showed that although the resident was listed on the unit 15‑minute check list, the check sheets were not signed from 11:45 a.m. through 12:30 p.m., and staff reported they were assisting with lunch and did not complete or document the checks during that period. During that same timeframe, the resident with aggressive behaviors was observed in their room watching television, and later was found wandering into another resident’s room and had to be redirected back to their own room. An LPN subsequently signed all residents’ 15‑minute check sheets while speaking with the surveyor and stated they documented that the aggressive resident was wandering for all the missing time slots based on finding them in another resident’s room at 1:04 p.m. Staff interviews revealed confusion about why this resident was on 15‑minute checks, with one RN stating there was no note explaining the reason and that staff had the checks stopped when they could not determine the rationale. The DON stated that 15‑minute checks were typically used for 72 hours and then reassessed, and that the need for checks should be reflected in the care plan, care cards, electronic notes, and shift‑to‑shift communication, with all staff responsible for performing and documenting the checks. The failure to consistently implement and document the ordered 15‑minute checks for this resident with a history of aggressive and abusive behaviors placed other residents at risk for abuse.
Failure to Allow Hospitalized Resident to Return and Inadequate Discharge Process
Penalty
Summary
The deficiency involves the facility’s failure to allow a resident, who had been transferred to a hospital, to return to their previous room or to the facility upon bed availability, contrary to the facility’s transfer and discharge rights policy and regulatory requirements. The resident had diagnoses including Parkinson’s disease with dyskinesia, unspecified dementia with anxiety, and atherosclerotic heart disease, and was assessed as significantly cognitively impaired but usually able to understand others and make themselves understood. The resident’s comprehensive care plan included a behavior focus with interventions such as diversion, redirection, 1:1 supervision, television, and 15‑minute checks. According to progress notes, the resident was transported to a hospital after being found in another resident’s room. The Medical Director documented that, although they had previously told the family that the facility could manage the resident’s behaviors, the events leading to the hospital transfer changed the situation, and the facility informed the family that they could not meet the resident’s needs for discharge back from the hospital. The Social Worker documented informing the family that the facility would need to discharge the resident because it was unable to meet the resident’s needs at that time, and directed the family to the hospital social worker/discharge planner for assistance with alternative placement. The Social Worker also discussed packing the resident’s belongings and provided contact information for the facility biller when the family inquired about redirecting the resident’s benefits. In interviews, the DON stated that after the resident was found in another resident’s room, the resident was placed on consistent 15‑minute checks and that the resident had to be on a locked unit due to known exit‑seeking behaviors. The DON further stated the facility chose not to take the resident back when they were cleared for discharge because the facility had not concluded its investigation and believed it could not continue 1:1 supervision after 15‑minute checks had failed. The family member reported being told by the emergency room physician, based on information from the facility, that the resident would not be welcomed back, and stated that facility staff never met with them regarding discharge, did not provide options for alternative placements, and that the resident was instead sent to another hospital unit designed to hold residents with behaviors while awaiting nursing home placement. The Administrator confirmed that this other hospital unit was used for residents who were hard to place, usually due to behaviors.
Failure to Follow Care Plans Results in Resident Falls Due to Neglect
Penalty
Summary
Three residents experienced neglect due to staff failing to follow established care plans and facility policies. One resident with severe cognitive impairment and a history of dementia was not offered toileting opportunities every two hours as required by their care plan. Documentation showed that the resident was only offered toileting once per shift, and there was no evidence of two-hourly toileting prior to the incident. This failure led to the resident attempting to toilet themselves, resulting in a fall and bruising. Another resident, also with severe cognitive impairment and multiple diagnoses including vascular dementia and Alzheimer's disease, required two-person assistance for transfers according to their care plan. Despite this, a Certified Nurse Aide attempted to transfer the resident alone, which resulted in the resident being lowered to the floor due to non-compliance with directions and improper body mechanics. The care plan specifically indicated the need for two-person assistance with a mechanical lift, which was not followed. A third resident, diagnosed with Parkinson's disease and dementia, was at high risk for falls and required a bed alarm as part of their fall prevention interventions. After being put back to bed by staff, the bed alarm was not activated as required by the care plan. The resident was subsequently found on the floor next to their bed, and documentation confirmed that the bed alarm was not in place at the time of the fall. In all three cases, the failure to adhere to individualized care plans directly contributed to resident falls.
Significant Medication Error Due to Failure in Resident Identification
Penalty
Summary
A deficiency occurred when a nurse administered seven medications to a resident that were actually prescribed for another individual. The facility's medication administration policy required nurses to verify the resident's identity, check the drug label multiple times, and ensure the five rights of medication administration, including right resident, right drug, right dose, right route, and right time. Despite these protocols, the nurse failed to verify the correct resident and did not administer the medications at the ordered time, resulting in the resident receiving medications not intended for them. The resident involved had diagnoses of dementia, hyperlipidemia, and anxiety, with severe cognitive impairment documented. However, the resident was generally able to state their name when asked, and staff confirmed that the resident could usually identify themselves. The error was discovered after the nurse realized the mistake and reported it. Interviews with staff confirmed that the nurse did not follow the required procedures for resident identification and medication administration. The facility's investigation found that the nurse did not practice safe medication administration and failed to perform the five rights. The incident was considered a significant medication error, and the nurse responsible was terminated. The event was documented through interviews, record reviews, and direct observation of the resident, who appeared alert and engaged following the incident.
Failure to Report Resident Fall and Injury Timely
Penalty
Summary
The facility failed to ensure that all alleged violations of abuse, neglect, or mistreatment, including injuries of unknown source, were immediately reported to the State Agency. Specifically, a resident with severe cognitive impairment, Alzheimer's disease, unspecified dementia with behavioral disturbance, and type 2 diabetes was left unattended and fell while ambulating, despite their care plan requiring staff assistance for transfers and ambulation. The incident occurred on 2/29/2024, but was not reported to the Department of Health until 3/01/2024. The facility's policies required that Safe Events Reports be completed and referred to the appropriate personnel and reviewed with the Interdisciplinary Team. However, the Registered Nurse on duty was unaware that the Certified Nurse Aide had violated the care plan by allowing the resident to ambulate independently. The Certified Nurse Aide was also unaware of the resident's care plan requirements. This lack of awareness and failure to report the incident promptly led to the deficiency identified during the survey.
Failure to Implement Comprehensive Care Plans
Penalty
Summary
The facility did not ensure the implementation of a comprehensive person-centered care plan for five residents. Specifically, for three residents, 15-minute safety checks were not completed as required by their care plans. One resident was found after an unwitnessed fall with no documentation of 15-minute checks being done from 2:00 AM to 6:00 AM. Another resident had no documentation for 15-minute safety checks between 2:00 PM and 7:00 PM and was found after an unwitnessed fall, requiring hospital evaluation. The third resident was found on the floor after an unwitnessed fall, with no 15-minute safety checks documented during the specified period. These lapses in safety checks led to unwitnessed falls and minor injuries for the residents involved. Additionally, the facility failed to ensure that specific interventions were in place for two other residents. One resident's bed was not in a low position, and appropriate footwear was not on the resident, as required by their care plan. Another resident's bed alarm was not in place before the resident was put to bed, leading to an unwitnessed fall. These deficiencies were identified through record reviews, progress notes, and staff interviews, which confirmed that the required interventions were not consistently implemented, resulting in care plan violations.
Failure to Ensure Resident Safety and Adherence to Care Plan
Penalty
Summary
The facility did not ensure the resident's environment remained as free of accident hazards as possible for one resident reviewed for accidents. Specifically, Resident #15, who had diagnoses of heart failure, type 2 diabetes mellitus, and end-stage renal disease, was found on the floor with the bed not in a low position, the call light not within reach, and without socks on. The resident's care plan included interventions such as a low bed and appropriate footwear, which were not followed by the Certified Nurse Aide (CNA) responsible for the resident's care. The facility's investigation revealed that the CNA did not place a bed alarm on the resident's bed, did not ensure the resident had non-skid socks on, and did not place the call light within reach. Interviews with facility staff confirmed that the CNA was aware of the care plan requirements but failed to follow them. The CNA received education on following care plans to prevent falls and injuries after the incident. Other staff members also acknowledged the importance of adhering to safety instructions and completing required safety checks to prevent such incidents.
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Nursing homes near Malone
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| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| North Country Nursing & Rehabilitation Center | 29.5 mi | — | 0 | 0 |
| Massena Rehabilitation & Nursing Center | 30.6 mi | — | 0 | 0 |
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