Windsor Atrium nursing home cited for abuse prior to first COVID-19 death

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HARLINGEN, Texas — Cameron County continues to investigate an outbreak at two nursing homes in the City of Harlingen.

 The Windsor Atrium and Veranda Rehabilitation and Health Care account for 40% of all the cases in Cameron County.

In just four days the cases of covid-19 nearly doubled inside the Windsor Atrium nursing home, going from 12 cases to 25 cases.

As of April 15, Cameron County officials confirmed 33 positive cases of COVID-19 including one death at Windsor Atrium.

The two nursing homes just three miles apart, taking 10-minutes in the care.

Both nursing homes have a below average rating on the Medicare compare website

The centers for Medicare and Medicaid services recently cited and fined Windsor Atrium for abuse and neglect.

A trend the nursing home inspection records showed.

In 2017, the nursing home did not ensure expiration dates were labeled on patients medications.

Staff not reading instructions and giving residents their medication incorrectly, the inspections stating “LVN mixed r3 Protonix with water instead of apple juice to administer r3 via gastrostomy tube.”   

Surveyor had noticed the facility leaving several residents without hygiene care and oral care writing, “the director of nurses provided an undated resident room roster indicating there were 85 residents needing nail care and nine residents needing oral care.”

In 2018, a flu outbreak infecting nearly a dozen residents, and it wasn’t reported to state and health officials. CMS writing, “the facility did not report an incident of possible neglect to the state agency…this failure could place 115 residents at risk of neglect.”

A resident had fallen twelve times in just one month, the inspection writing, “the facility did not provide the type and amount of supervision necessary to prevent #95 from falling twelve times.”

In that same year, one resident stated she had been at the facility for a year and staff would help her use the restroom at first, but when the surveyor asked the resident why she no longer called for assistance, she told the inspector quote “What for? They tell me to go in my brief.”

In 2019 — 21 citations, the Texas average at 6.9 and the national average at 8.2.

In 2019 CMS found the current activity director was not a qualified therapeutic recreation specialist who met state requirements. 

The inspections stating, “The administrator responded saying that she had advertised the positions for 3 months and there was no applicants …and the current director was getting assistance from their sister facility’s certified director.” 

Additionally, Windsor Atrium continued to be cited for similar violations that year.  

Nurses administering the wrong medication on patients, inspections stating “LVN F applied [MEDICATION NAME] lubricant eye gel to R#2 in both eyes instead of administering Refresh [MEDICATION NAME] Solution in both eyes, per MD orders”

Not listening to physician’s orders when changing the number of prescribed drugs, or documenting conversations on the patients’ records. 

But one of the biggest trends inside the inspections showed over the last three years was Windsor Atrium had no written policies for several of these citations. 

I reached out to Windsor Atrium, and asked to speak with the administrator but was told she was on the other line. I left my information with a request for a callback, but have not heard back.  

Regency Integrated Health Services who owns Windsor Atrium has four other nursing homes across the Valley with below-average ratings. 

If you have a loved one at one of these facilities or a nursing home across the Valley and feel there is mistreatment or violations. Email me at cbenitez@kveo.com

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