- Associated Press - Monday, December 15, 2014

CONCORD, N.H. (AP) - An Effingham center that treats people with brain injuries must pay and train staff better and improve supervision of patients, according to a state report that follows an investigation into complaints of abuse and neglect.

In a report issued Monday, New Hampshire’s Department of Health and Human Services advised the state to continue barring admissions to Lakeview NeuroRehabilitation Center until several deficiencies are addressed. A spokesman for Gov. Maggie Hassan said the state will continue its two-month-old ban on state and local agencies placing patients at Lakeview.

The review follows complaints by the Disability Rights Center, including reports of sexual abuse of residents; residents leaving unattended; and residents hurting each other and staff. The center said one resident died after losing 50 pounds during a 10-week stay, while in another complaint, a 20-year-old woman slipped away from her residence when an employee left his post to respond to a disturbance. The woman spent the night in the woods; state Fish and Game officers found her 16 hours later.

A seven-member review team found chronic, acute staffing problems at the center along with deficiencies in training, communication, crisis management and oversight. Add the lack of a strong quality improvement program, and the patients were susceptible to unintended “bad outcomes,” the report found.

The first recommendation in the report: Pay more to recruit and retain skilled workers in the rural, isolated location. The report notes that Lakeview’s direct care workers earn less than employees at McDonald’s or Wal-Mart. In 2014, the center reported 83 staffers left - including 60 direct care workers, leaving 25 vacancies in that job.

Staffing is such a problem that employees often have to choose between doing their primary job - such as direct supervision - and helping out other staff or finishing paperwork. The report said Lakeview must guarantee supervision is never compromised because of staffing shortages and recommended creating a dedicated crisis team so direct care workers aren’t pulled away from their regular duties.

The report also calls for better communication among staff, especially giving direct care workers real-time access to critical information about each patient’s condition that can guide day-to-day-operations. It also recommends better training, monitoring and evaluation of staff and a better way to evaluate a patient’s medical management issues, including whether a patient requires more supervision.

Karen Rosenberg, senior staff attorney at the Disability Rights Center, said the center is pleased with the report’s strong recommendations but worried that Lakeview may not be able to fix the problems.

“The findings, they’re not just fleeting, they’re chronic,” she said. “They’re pervasive.”

Lakeview Administrator David Armstrong said the center “intends to fully comply with the recommendations in DHHS’s review and has already begun to address the concerns” including hiring outside experts as needed. The center has until Dec. 31 to submit a plan to correct the deficiencies.

The panel also recommended DHHS review regulations to ensure they address all areas of patient safety and program quality, and said the state should continue to freeze admissions to Lakeview until DHHS approves its corrective plan.


The DHHS report can be found by typing Lakeview into the Facility Name search window at: https://1.usa.gov/1uNX86h

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