‘They don’t have enough staff’: central Pa. nursing home endangered residents, state says

On two days in November, staff at Claremont Nursing and Rehabilitation Center failed to distribute hundreds of doses of medications for a host of conditions including pain, diabetes, heart failure and mental illness, according to the Pennsylvania Department of Health.

The department said “these missed medications had the potential to cause the residents discomfort or pain, to exacerbate medical conditions including blood pressure, cardiac and diabetic issues, increase the potential for seizures, and jeopardize the health and safety.”

It prompted the department to declare “immediate jeopardy” at the skilled nursing facility on the outskirts of Carlisle in Cumberland County. Immediate jeopardy, the most severe designation the department can apply, means residents are in immediate danger of severe harm.

The declaration, made Dec. 7, marked the second time in a month the health department deemed Claremont residents to be in immediate jeopardy. The first one came after the health department determined there was a delay in beginning resuscitation on a resident who stopped breathing and had made it known he wanted lifesaving aid in such a situation. Because dozens of other Claremont residents also want such aid, the department concluded the possibility of delay jeopardized all of them.

Claremont has been carrying out state-monitored plans of correction intended to prevent the lapses from happening again.

Officials of Allaire Health Services, the New Jersey-based owner of Claremont, told PennLive in a written statement, “While we agree with some of the [health department] findings during recent inspections, there are other findings with which we do not agree.” Despite that, they are addressing all issues identified by the state, according to the statement signed by CEO Benjamin Kurland and Kyle Kramer, the chief strategic officer.

They blamed the problems on former management, which they said had been relying almost entirely on aides who worked for agencies, and impacts of the COVID-19 pandemic, which has exacerbated staffing shortages throughout health care.

“While agency staff members are a positive resource, it is not the same as permanently hired staff members who embrace company values, are trained in organizational culture, and committed to delivering care at a high level of commitment and quality. The void of permanent staff who are formally engaged and definitively committed to quality and exemplary performance is a major cause of the issues Claremont has experienced,” they said.

The problems are detailed in a pair of inspection reports recently made public, more than a month after each instance of immediate jeopardy.

Claremont was long a Cumberland County-owned, non-profit facility. Over the objections of a group of county residents, county commissioners sold it to Allaire, a for-profit, in mid-2021.

The missed medications, which happened during the day shifts on Nov. 6 and Nov. 24, involved 14 residents.

All told, a total of 269 doses of medications were missed on those days, with some residents missing as many as 20 doses, according to a publicly-available inspection report.

The health department concluded the missed doses resulted from low staffing. A Claremont employee also told the department that most of the aides who care for residents work for agencies, not directly for Claremont, according to the inspection report.

The employee said “it is difficult to manage them at times … it is difficult to get the agency aides to do their work and they are often disrespectful of supervising nurses.”

The inspection report includes comments from a Claremont resident who described not getting any medications during the day shift on Nov. 24, which was Thanksgiving, and who recalled going without medications during another day shift.

According to the department, the resident said “she kept mentioning it to the nurse aide who said they kept telling the nurse, but the nurse never came.”

Another resident told the department, “they don’t have enough staff to take care of us. We shouldn’t have to go without showers or care. I don’t want to go somewhere else, but I may have to so I can get the care I need.”

The department further said that in looking at staffing levels for three days in November, it concluded Claremont failed to provide the state-required minimum level of direct care per resident on two of the days.

It found the facility provided 2.64 hours of care on Nov. 24 and 2.37 hours on Nov. 26; Pennsylvania law requires at least 2.7 hours.

The department also faulted Claremont for continuing to take in new residents under such circumstances.

All told, Claremont had between 170-180 residents during that period.

Claremont was required to carry out a plan of correction intended to prevent staffing emergencies. The plan includes new agreements with staffing agencies, using enhanced pay to get staff to cover unfilled shifts, referral and retention bonuses, administrators helping to offset staffing shortages and halting new admissions during times of low staffing.

Kurland and Kramer, in their responses to PennLive, said Claremont has decreased agency usage by more than 20% since late 2021, and has hired 80 certified aides and registered nurses during the past three months.

In addition to the two recent immediate jeopardy declarations, the health department cited Claremont for a range of problems during late 2022, with the problems often found during inspections resulting from complaints.

In September, for example, the department found what it called a “pattern” of residents not being served lunch items they selected, in some cases involving food requested for medical reasons. In one instance, a resident who ordered a salad and seasonal fruit received only “a small cup of applesauce.”

In July, the department found a pattern of failing to make sure residents were provided with scheduled showers, and lapses in pest control. Other problems found in recent months involve instances of neglect and lapses in care for people who are incontinent or who have urinary catheters.

Kurland and Kramer said Claremont is carrying out multiple initiatives to improve care, including seeking more input from residents and staff.

“Feedback from residents and staff indicates that our stakeholders agree the facility is heading in the right direction and are extremely pleased with the current initiatives,” they said.

Pennsylvania has about 700 skilled nursing homes caring for about 80,000 people.

People can view inspection reports for nursing homes at this website run by the Pennsylvania Department of Health. Click on the county where the home is located, find the facility on the list and select the option to view patient care surveys.

The health department regularly inspects facilities and also does inspections in response to complaints. People can notify the department of a complaint or concern by calling 1-800-254-5164. People can also use an online form or send an email to c-ncomplai@pa.gov. Or people can fax their concern to 717-772-2163, or mail it to:

Division of Nursing Care Facilities Director

Pennsylvania Department of Health

Division of Nursing Care Facilities

625 Forster St., Room 526, Health and Welfare Building

Harrisburg, Pa., 17120-0701

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