|August 6, 2003|
IDPH DISCIPLINES FIVE COOK COUNTY FACILITIES
SPRINGFIELD, IL The Illinois Department of Public Health has taken disciplinary action against five Cook County nursing homes:
Glenshire Nursing & Rehab Centre was fined $5,000 (Statement of Violation), for an incident in which a resident, who was totally dependent on staff for toilet use, was left unattended by staff in a basement bathroom and was not found for approximately seven hours. When the resident was found, he had multiple bruises and low blood sugar. Department investigators learned an employee assisted the resident to the bathroom and then went to work with other residents on another floor. When the employee returned to the basement, she did not see any residents in the gym and assumed someone else had returned the resident to his floor. The employee did not check the bathroom before leaving work for the day.
Glenwood Healthcare & Rehab was fined $10,000 (Statement of Violation), for failure to determine whether a new resident had a "Do Not Resuscitate" order, to assess a change in a resident's condition and to follow the facility's policy on initiation of cardiopulmonary resuscitation and for terminating CPR before calling the attending physician or emergency services. An employee said she noticed the resident looked weak and was not very responsive and reported it to a nurse. Department investigators found no documentation of the resident's change in condition and no evidence that an assessment was done. A few hours later, the resident was found not breathing and he had no pulse. An employee initiated CPR without determining the resident's DNR status and whether resuscitation efforts were warranted and then arbitrarily stopped CPR. During the emergency procedure, the facility did not contact the attending physician or emergency services.
Imperial of Hazel Crest was fined $5,000 (Statement of Violation), for failure to properly supervise a resident with a drug and alcohol problem and for failure to follow its own policies regarding alcohol and drug use and pass privileges. Department investigators learned the facility continued to give the resident passes to leave the facility, sometimes for several days at a time, despite having suspicions that he was still using alcohol and drugs and that he might have been involved in criminal activity in the community while out on pass. Police told a surveyor they had been to the facility several time to question the resident about home invasions and burglaries that had occurred in surrounding communities, but were always told he was out of the facility. The resident was later arrested on charges of burglary and homicide.
Manorcare at Palos Heights West was fined $5,000 (Statement of Violation), for an incident in which a resident sustained minor injuries after leaving the facility unnoticed. The resident was found by neighbors, who returned him to the facility. The resident had made numerous threats and attempts to leave the facility prior to this incident. The facility was aware of the resident's behavior, but failed to implement a process to prevent him from eloping.
Victorian Manor Healthcare & Rehabilitation was fined $10,000 (Statement of Violation), for failure to adequately supervise a resident who sustained a fractured nose and cut lip after wandering away from the facility unnoticed. The resident apparently went out the front door, which is not alarmed, when the receptionist left her desk to go to the mail room. Police found the resident near railroad tracks, which are about four blocks from the facility, and took her to the hospital.
All five facilities have requested hearings on the Department's actions. Imperial of Hazel Crest's hearing is scheduled to begin Jan. 13, 2004. No hearing dates have been scheduled for the remaining facilities.
of Public Health
535 West Jefferson Street
Springfield, Illinois 62761
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