Two Nursing Homes Fined Following Resident’s Injury, Medication Error

State health officials fined two nursing homes following incidents in which residents were injured and suffered complications after doctors’ orders were not followed.

Apple Rehabilitation of Middletown was fined $1,635 by the state Department of Public Health (DPH) following an incident December in which a resident chewed an index finger until bone was exposed.

The resident had osteoporosis and dementia, and a care plan noted that the resident had a habit of chewing the right index finger, according to DPH. On Nov. 30, 2015, a physician directed staff to keep the resident’s right hand covered with a sock to prevent chewing.

On Dec. 16, the resident was found with the right index finger in the mouth and blood “all over” the face, according to the citation. The index finger’s bone was exposed, the citation said.

The injury was treated with an antibiotic cream, cleaned with saline, wrapped, and covered with a sock, DPH said.

An investigation found there were multiple occasions, including on Dec. 16, when the resident’s hand was not covered with a sock as stipulated in the physician’s orders. The physician’s orders were missing from the resident’s clinical record on Nov. 30, according to DPH.

Apple Rehabilitation did not return a call seeking comment.

Sheriden Woods Health Care Center in Bristol was fined $1,740 for failing to monitor a resident’s blood sugar and administer medication as ordered.

On Aug. 12, 2015, a diabetic resident receiving hospice care at the facility had several high blood sugar readings between 2:38 and 6:20 p.m., according to the citation. Soon after, the resident’s family asked that the resident be transferred to a local emergency department.

According to DPH, the resident—who also had colon cancer, dementia and congestive heart failure—was diagnosed at the emergency department with diabetic ketoacidosis. The condition is a diabetes complication that occurs when the body produces high levels of acids called ketones; it can result in a diabetic coma or death.

In speaking with staff and reviewing clinical records, DPH found that staff failed to obtain the resident’s blood sugar readings as prescribed from the afternoon of Aug. 10, 2015, until the afternoon of Aug. 12, 2015.

Staff also failed to administer the resident’s insulin medication as ordered between 11:53 a.m. on Aug. 10, 2015, and 3 p.m. on Aug. 12, 2015, according to the citation.

Officials at the Bristol facility did not return a call seeking comment.health logo

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