Lebanon nursing home faces penalties for care deficiencies

By CLARE SHANAHAN

Valley News Staff Writer

Published: 10-04-2024 8:00 PM

LEBANON — During multiple site visits to Lebanon Center in July and August, U.S. regulators reported finding  21 “deficiencies,” where the nursing home failed to meet federal health and safety standards.

The deficiencies include administering medication incorrectly, failure to take infectious disease precautions, emergency preparedness issues and problems with general operations, the Centers for Medicare and Medicaid Services, or CMS, reported. 

If Lebanon Center doesn’t take corrective measures, CMS has said it will stop issuing Medicare and Medicaid payments for new patients, starting Friday.

CMS is an agency within the U.S. Department of Health and Human Services that oversees 1.2 million nursing home residents whose care is mainly paid for by the federal government.

Lebanon Center is a 110-bed facility off Route 120 that offers short-term rehabilitation and long-term and respite care. As of Aug. 5, the facility had 85 residents, according to CMS. Lebanon Center is owned by Genesis Healthcare, a national for-profit chain with 250 centers in 22 states.

If federal standards continue to be unmet, CMS has indicated will stop all payments to Lebanon Center in January.

A spokesperson for Genesis, which is headquartered in Kennett Square, Penn., told the Valley News this week that it has taken action to address the “identified concerns” and intends to remain open.

“At Lebanon Center, our primary focus is providing the highest quality care to our patients and residents,” Genesis spokesperson Nerida Brennan said via email Tuesday. “We are fully committed to working with state and federal regulators to ensure that we meet all necessary standards at the facility.” 

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Brennan did not specifically address questions about Lebanon Center’s response to deficiencies or provide a plan of correction.

CMS confirmed that the Lebanon Center administration has filed plans, but but did not share them with the Valley News this week. 

If the facility is still not in compliance with federal standards by Jan. 11, CMS has indicated it will end its provider agreement and and relocate residents who receive Medicare or Medicaid benefits to facilities with active certifications.

In 2017, Brookside Health and Rehabilitation Center in White River Junction closed shortly after CMS stopped issuing payments. A investigation found numerous issues related to food safety and health violations at the Christian Street nursing home, which is now being converted into apartments. 

If Lebanon Center — or any similar facility — closes it could worsen an ongoing shortage of emergency room and inpatient beds at Dartmouth Hitchcock Medical Center, Dartmouth Health CEO Joanne Conroy said Tuesday in an email statement.

The closure of skilled nursing facilities makes hospital overcrowding worse in multiple ways, Conroy said. Patients who need care after their hospital stay may be stuck in the emergency department or in inpatient beds. Access to care, such as  physical and occupational therapy, that helps patients recover faster can also be delayed.

“Any loss of post-acute capacity in New Hampshire will exacerbate the capacity constraints felt at DHMC,” Conroy said.

Below average

The Lebanon Center is one of two facilities Genesis operates in the Upper Valley. The second facility is Elm Wood Center at Claremont. 

 At Elm Wood, CMS found deficiencies on June 13, according to a report. A followup survey was conducted on Aug. 6, but information about this survey isn’t yet available.

Medicare.gov uses CMS reports that show health, staffing and other quality measures to rate nursing home quality.

Medicare.gov rates Lebanon Center two out of five stars, or below average and Elm Wood Center has one out of five stars, or much below average.

Deficiencies at the Elm Wood Center include administering incorrect medication to residents, failure to ensure residents have access to certain care, understaffing and improper medication management.

Elm Wood Center is now in compliance with CMS regulations, Brennan, Genesis’ spokesperson, said via email Thursday.

Medicationand patient safety

The surveys conducted at Lebanon Center on July 9 through 11, and on Aug. 5 found deficiencies across many areas of care.

Multiple residents at Lebanon Center were given incorrect medications, either because they did not match the issued prescription or because their use was not allowed by facility or CMS guidelines, according to CMS records.

For one patient, staff administered the incorrect dose of a medication that prevents blood clots. In a separate incident, a patient was prescribed antianxiety medication with no stop date on the prescription. The patient received 10 doses of the medication beyond the federal limit.

In another incident, the facility failed to follow its own antibiotic use protocols. Specifically, in April and June, seven residents were prescribed antibiotics to treat urinary tract infections, which went against facility guidelines.

Administering antibiotics to treat UTIs in older adults poses more harm than potential benefit, according to research from the Journal of Clinical Infectious Diseases.

Beyond improperly administering medication, Lebanon Center failed to take precautions to prevent the spread of infectious disease among at-risk patients and did not properly report a COVID-19 outbreak.

Staffing, record keeping and administration

Lebanon Center has had insufficient weekend staffing since at least January, according to CMS.

Between January and March, staffing data showed “excessively low” staff on the weekends. More recently, a review of reports between June 9 and July 10 revealed the facility did not meet its own staffing requirements on six of the nine weekend days CMS reviewed.

Currently, federal law requires nursing homes to set their own staffing requirements based on facility needs.

The Lebanon facility requires enough coverage to provide 1.63 hours per patient per day of care from nurses aides. On the substandard days, coverage ranged from 87% to 96% of this threshold.

Records showed one employee did not receive abuse, neglect, exploitation and misappropriation of resident property training before beginning work at Lebanon Center in April.

Staff must receive this training as part of their orientation.

Regulators found numerous fire safety violations on Aug. 5, according to the report. These issues ranged from improperly labeled flammable materials to unsafe or ineffective smoke barriers, fire doors and exit ramps.

In one instance, an exit ramp had broken, leaving uneven and loose boards that moved when the ramp was in use. In another case, there was a hole large enough to step down into in the ramp’s center.

Falls and lackof communication

One person who is not surprised by the deficiencies at Lebanon Center is Sarah Sears, whose mother lived on the second floor of the facility from November 2019 until her death in August 2023.

Dangerous falls, lack of communication and overall poor quality of care characterized Sears’ mother’s time at the facility, she said.

“Genesis never called you, so every time the phone rang I knew she fell. That’s the only reason they called me,” Sears said.

Priscilla Sears, Sarah’s mother, was a professor of English and women’s studies at Dartmouth College for over 40 years. She loved music, had a unique way of looking at the world and would astound her daughter with brilliant observations and insightful conversations, even close to her death. Priscilla had Lewy Body Dementia, which progresses over time and causes a decline in thinking and movement abilities; this led her to Lebanon Center.

Priscilla fell at least 35 times while living at the nursing home, her daughter said. She describes the 35th incident as “the big fall.”

In this incident, Priscilla hit her head and severely bruised the area above her eye.

When Sears requested interventions to limit her mother’s falling, changes either weren’t made or were delayed, she said. Ultimately, she herself placed pool noodles over the rails on the bed and chair in her mother’s room to cushion the hard metal surfaces in the event of another fall.

It was difficult for the family to reach Priscilla while she lived at Lebanon Center and her own ability to communicate internally and externally was very limited, Sears said. In a video, Sears searches her mother’s room for a telephone, which she ultimately finds unplugged and placed on the bottom shelf of a bedside cabinet.

CMS regulations give residents the right to make and receive private phone calls and reasonable access to c ommunication devices.

Overall, Sears described the state of Lebanon Center and her mother’s experiences there as “horrifying.”

Clare Shanahan can be reached at cshanahan@vnews.com or 603-727-3216.