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Effingham rehab center told to come up with plan by Dec. 31

Union Leader Correspondent

December 15. 2014 9:46PM
The 88-bed Lakeview NeuroRehabilitation Center has patients from six states and New Hampshire. (JOHN KOZIOL/Union Leader Correspondent)

EFFINGHAM — A six-person review team found that Lakeview NeuroRehabilitation Center’s “chronic and acute staffing deficits,” improper supervision, as well as deficiencies in training, communication and crisis management contributed to “problematic incidents” and “bad outcomes” for patients.

The report, released Monday by the Department of Health and Human Services, calls upon Lakeview to submit by Dec. 31 “an acceptable Plan of Correction to address and ameliorate the issues identified in the report and to come into compliance with statutory and regulatory requirements.”

Lakeview serves youths and adults with acquired brain injuries and developmental disabilities and was the subject of two white papers released on Sept. 30 by the New Hampshire Disability Rights Center (DRC) that were prompted by the death of a patient.

Ultimately, said DRC staff attorney Karen Rosenberg, the center would like to see the 88-bed Lakeview shuttered and its patients transferred to community-based care centers. In New Hampshire, Lakeview also operates a smaller facility, The Meadows in Belmont, which was not part of the DRC’s original complaint to the DHHS.

In response to the DRC allegations, Gov. Maggie Hassan directed Health and Human Services to immediately stop admitting new patients to Lakeview and ordered two reports, including the one released Monday.

Lakeview Administrator David Armstrong said the facility would “fully comply” with the report’s commendations, adding that Lakeview “has already begun to address the concerns” in the document and would hire “outside experts as needed.”

“We intend to use this report as an opportunity to further advance the quality of services we provide,” he said.

Deputy DHHS Commissioner Marilee Nihan said the report “...raises serious concerns about Lakeview’s ability to provide quality care in a safe and effective way to this vulnerable population.” She noted that the findings “illustrate that Lakeview needs to greatly improve and maintain its staffing, training, and quality systems.”

Salaries for direct-care staff “are not competitive,” and are eclipsed by wages paid at a local retailer and fast-food restaurant, the report states.

The turnover rate for direct care staff is 29 percent, the report said, with Lakeview officials adding that the facility has seen “15 professional clinical staff, five health and safety officers, three nurses and 60 direct care staff” leave in 2014.

In telephone interviews with seven parents/guardians of current Lakeview patients, the DHHS said there were frequent expressions that “there is not enough staff in the residential programs to maintain the one-to-one staffing,” especially at night.

During one telephone interview, a parent told investigators that their child was undergoing surgery that day after somehow obtaining a bottle of nail polish at Lakeview and later ingesting both the polish and the bottle.

On Monday, Rosenberg praised the report’s recommendation to continue the state moratorium on admitting new patients to Lakeview until Lakeview had submitted its plan.

But she was not optimistic about Lakeview coming up with a plan and being able to follow it.

“I have serious concerns about Lakeview’s ability to comply with the plan because the type of issues we cited and the DHHS cited are long-standing, chronic issues” that have been identified previously but not corrected, said Rosenberg.

Although some current Lakeview patients may need the specialized care that only Lakeview can provide, “most, if not all,” she observed, could be cared for in a less costly manner in their home communities.

Nihan said DHHS is “developing transition strategies for New Hampshire patients” at Lakeview — about six states send patients there — but disagreed with Rosenberg that the majority of them can be readily relocated.

If Lakeview does not submit an acceptable plan by the end of the month then DHHS “has a number of measures that it can take,” said Nihan, including directing the corrective plan itself; imposing fines; and/or suspending or revoking Lakeview’s operating license.

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