March 05, 2015FFINGHAM — The New Hampshire Department of Health and Human Services (DHHS) released Lakeview NeuroRehabilitation Center's Plan of Corrective Action earlier this week.
Last fall, Lakeview was the subject of a Disability Rights Center report alleging numerous incidents of abuse, mistreatment, and neglect. New Hampshire Governor Maggie Hassan ordered the DHHS to investigate the allegations and follow up with its own report. As a result, Lakeview was prohibited from accepting new patients until the facility developed and put into place a corrective action plan.
The Plan of Corrective Action included a cover letter, signed by both Lakeview Chairman and CEO Chris Slover and President and COO Dr. Tina Trudel. The letter stated that, "… we take the findings of the December 9, 2014 licensing report very seriously. We know that as an organization we must change our culture and transform the operations and clinical services of Lakeview."
The Corrective Action Plan described initiatives to improve staff quality and quantity through leadership changes, more proactive training, and greater overall organizational accountability. The organization has already hired a new Director of Quality Assurance/Performance Improvement (QAPI) to establish performance indicators and communicate lessons learned to direct care staff.
Improved staff availability and training
Understaffing and insufficient staff training were two key concerns highlighted in the investigation. Lakeview has documented its plans to ensure that the number of clients admitted and the level of attention required by each does not exceed the facility's capability and resources. The organization has also begun scheduling extra direct care staff beyond mandated levels to prevent staff "call outs" from leading to unsafe situations for patients. In addition, Lakeview will provide the DHHS with weekly staffing reports that include the names of scheduled staff and details regarding any staffing shortages.
Lakeview also increased the starting salary for its rehabilitation specialists and education aides from $10.00 an hour to $10.50 an hour.
In addition, Lakeview hired Durante Advantage Training to train staff. The training will include appropriate crisis management practices, such as when the use of physical intervention is appropriate, steps to take in the event of a patient's unauthorized absence, and how to handle patient injuries requiring more than basic first-aid.
Lakeview has also contracted the services of a third-party monitor, Fedcap Rehabilitative Services, Inc., to assist with ongoing systems improvements, serve as a consultant, and monitor the organization's improvement efforts. Last month Fedcap began working with Lakeview's new Director of QAPI to design a comprehensive quality improvement strategy for the organization. Fedcap will provide feedback to all relevant parties, including the DHHS.
Better documentation and accountability
Lakeview will also require staff to electronically document every critical incident and will provide a root cause analysis to the DHHS within seven calendar days of any Level III or IV incident report. The reports will indicate how the cause of and/or response to the incident relates to staffing, training, supervision, and quality assessment review.
In addition, any allegations of client abuse or neglect must be reported to the Health Facility Licensing Unit within one day, followed by a complete description of specific actions taken regarding the abuse or neglect allegation within five calendar days.
Fedcap will continue to serve as Third Party Independent Monitor (TPIM) until Lakeview achieves full compliance and implementation of the Plan of Correction.
"Not good enough"
The Disability Rights Center does not believe that the proposed plan of corrections goes far enough to resolve Lakeview's difficulties. According to the organization's Executive Director Richard Cohen, Lakeview's problems have been going on for several years with few signs of improvement.
"These are not new issues. This has been a continuing pattern;" said Cohen.
The Disability Rights Center had initially called for the state to shut down Lakeview. Instead, the DHHS prohibited Lakeview from accepting new patients until its problems were resolved.
"A general hospital wouldn't be allowed to operate under these conditions," Cohen said. "Given their track record, I don't think it makes sense to allow them to continue to operate."
Cohen expressed several concerns with the Correction Plan, starting with the increased staff salaries. He pointed out that the market range for direct support staff is between $11.60 and $25 per hour, a far cry from Lakeview's recent upgrade to $10.50.
"This salary increase doesn't even come close to that," he said.
In addition, he stated that the Corrections Report offers no real plan for improving the quality of the clinical supervisory staff.
"We continue to wonder why the state allows this facility to remain open," said Cohen. "The facility doesn't have the capacity to meet its current needs. This plan could take months, if not years, to bring it up to speed."
The State is awaiting an independent report from an outside agency before making any further decisions.