By Daymond Steer
CONCORD – The state of New Hampshire is giving Lakeview NeuroRehabilitation Center until Dec. 31 to come up with a plan to address "serious concerns" with the facility that the state identified in a recently released report. Lakeview responds that it's already getting to work making changes.
Lakeview NeuroRehabilitation Center is an 88-bed residential facility, located in Effingham, that cares for individuals with physical, neurological, cognitive and behavioral impairments.
A few months ago, Gov. Maggie Hassan ordered New Hampshire Department of Health and Human Services to conduct the review after the New Hampshire Disabilities Rights Center lodged a complaint against Lakeview. The results of the review were released on Monday.
"The review found that chronic and acute staffing deficits; not maintaining proper levels of supervision at all times; admitting residents with a higher level of acuity than the facility can effectively handle; deficiencies in training, communication, crisis management and program oversight; and lack of a robust quality improvement function have contributed at times to problematic incidents and 'bad outcomes' for program residents," states a press release from the N.H. Department of Health and Human Services.
Lakeview must submit a plan to correct those problems by Dec. 31. Lakeview's license to operate in New Hampshire is at stake.
The plan of correction must address:
• How the licensee intends to correct each deficiency.
• What measures will be put in place, or what system changes will be made to ensure that the deficiency does not recur.
• The date by which each deficiency shall be corrected.
Once the correction plan is accepted, the state will post it online along with the inspection report.
On Monday, Lakeview released a statement saying it intends to "comply" with the state's recommendations and has already began working on them. Lakeview said it will hire "outside experts as needed." Lakeview wants to meet or exceed state standards.
"We intend to use this report as an opportunity to further advance the quality of services we provide," said a statement from Lakeview. " We have extensive quality assurance measures in place that will guide our efforts. As evidence, in the past month our accreditation by both the Commission on Accreditation of Rehabilitation Facilities (CARF) and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) have been renewed."
Marilee Nihan, deputy commissioner for N.H. Department of Health and Human Services, commented on state's report.
"This report raises serious concerns about Lakeview's ability to provide quality care in a safe and effective way to this vulnerable population," said Nihan. "While I do appreciate the difficulties and complexities in providing safe care and treatment to those with severe brain injuries, individuals must be provided with safe, quality care. The findings in this report illustrate that Lakeview needs to greatly improve and maintain its staffing, training, and quality systems."
N.H. Disability Rights Center staff attorney Karen Rosenberg was "very pleased" with the state's report.
"It validates the findings that we made in the two reports we issued following the death of J.D., the resident who was there back in 2012," said Rosenberg. "Specifically, that there are chronic deficiencies in terms of numbers of staff, training for staff, supervision, that there's not adequate communication among the clinical and direct care staff, there's a lack of oversight and all kinds of things that we found that really place people in harms way or potentially at risk of harm."
Rosenberg questions Lakeview's ability to follow through in the long term.
"The reason I feel that way is because we have been in conversations with Lakeview over the course of years," said Rosenberg, adding she's been looking into Lakeview since 2010. "Lakeview represented to us years ago that they were going to be making changes and they really haven't."
The New Hampshire Disability Rights Center is based in Concord. It describes itself as "New Hampshire's designated Protection and Advocacy agency and is authorized by federal statute 'to pursue legal, administrative and other appropriate remedies' on behalf of individuals with disabilities. DRC is a statewide organization independent from state government or service providers."
Understaffing and turnover, particularly of Lakeview's direct care staff, was a major theme of the state report. The report said 60 direct care staff personnel members left Lakeview in 2014. It said as of now, there are 25 vacancies in the direct care class of positions. One of the state's recommendations was that Lakeview must never lower supervision levels for lack of sufficient staffing.
Another set of reports released by Department of Health and Human Services described two instances where patients were able to "elope" from the facility. The reports say that the two clients involved did not get the required supervision in terms of the statutes and rules governing residential treatment facilities.
In the first instance, a 20-year-old woman went missing around 7 p.m. on Aug. 24 and Fish and Game found her unharmed the next morning in the woods. The employee assigned to the client lost sight of the woman after trying to help co-workers with a disturbance. In the second instance, an employee lost sight of a client while doing paperwork. The second patient was found within the day.
Lakeview responded to the findings on the elopements by describing what they are doing to prevent such incidents from happening again. According to Lakeview, the first patient was wearing two sets of GPS tracking gear and one set worked for a short time and the other failed. Lakeview says it now tests its GPS gear on a daily basis. Lakeview implemented a checklist to make sure the proper staffing levels are maintained. Lakeview's leadership is conducting unannounced quality assurance walk-throughs. Lakeview has also installed additional door and window alarms.
Former Lakeview employee Mike Corthell was also pleased with the report. Corthell raised concerns about Lakeview's staffing levels and patient and staff safety in 2012 when he was a Lakeview shift supervisor
"I hope it's a happy ending for a lot of patients there," said Corthell who believes that the patients would be better served at a non-profit facility. "I'm pretty happy. I'm speechless."
At the end of September, Gov. Maggie Hassan barred state government agencies, and organizations the state contracts with, from placing new patients at Lakeview NeuroRehabilitation Center.
The report released Monday said the admissions freeze should continue until Department of Health and Human Services can approve the corrective plan.
"Further, resumption of admissions shall be commensurate with compliance with the corrective plan as documented by DHHS monitoring reviews," states the report.
During the fall, the N.H. Disability Rights Center released reports alleging that patients are being mistreated and that one, named J.D., died after "horrific" neglect. Last fall, Lakeview said it "strongly disputes" the Disability Rights Center's reports.
The Disability Rights Center's report also highlighted an instance where a teenage girl went missing from Lakeview for a couple of days last year. The teen "wandered off" in her pajamas and was found on Green Mountain. This incident made headlines in a number of media outlets.
After the fall report was released, Lakeview didn't directly address J.D.'s death. However, administrator David Armstrong did say that Lakeview handles patients who may harm themselves or others. "We do care for a number of individuals who engage in high-risk behavior, behavior which frequently affects their own well-being or potentially that of others," said Armstrong. "We believe that everyone deserves a chance to succeed, and therefore accept individuals who we know will present treatment challenges."
Hassan released a statement about the report from Department of Health and Human Services.
"This report on the licensing review is part of a larger process to respond to the complaint by the Disability Rights Center," said Hassan. "This process also includes the department engaging an outside expert, whose contract was approved at the last Governor and Council meeting on Dec. 3, to review Lakeview's infrastructure and policies to determine whether it is capable of providing the necessary supports and services to residents, as well as an outside review of the department's handling of Lakeview complaints."