HOUGHTON, NY - A state health inspection at Houghton Rehabilitation & Nursing Center revealed that the facility failed to implement basic infection control protocols for residents displaying respiratory symptoms and continued to employ uncertified nursing assistants in direct care roles beyond the legally permitted timeframe, according to findings from a May 2025 inspection.
Respiratory Outbreak Protocol Failures Put Vulnerable Residents at Risk
The facility's most concerning violation involved three residents who developed respiratory symptoms including wet coughs, hoarse voices, and sore throats between April 26 and April 30, 2025. Despite testing these residents for COVID-19, influenza, and respiratory syncytial virus (RSV), staff failed to implement isolation precautions while awaiting test results.
According to the inspection report, Resident #28 began experiencing symptoms on April 28, with documentation noting "a moist cough and was requesting cough syrup from the doctor." By April 29, this resident's condition had worsened to include "respiratory symptoms, a congested cough and chills" with lungs that were "rhonchorous throughout" - medical terminology indicating low-pitched gurgling sounds consistent with fluid or mucus in the airways.
Similarly, Resident #42 displayed symptoms starting April 26, progressing to a "congested cough and hoarse voice" by April 29. Resident #67 also developed respiratory symptoms requiring testing on April 30.
Despite these clear indicators of potential respiratory infection, observations on April 30 found no isolation precaution signs posted outside the residents' rooms and no personal protective equipment available for staff entering these areas. When questioned, Licensed Practical Nurse #1 acknowledged that facility policy required placing residents with respiratory symptoms on droplet isolation precautions until test results were received, stating they "did not know why they were not on isolation precautions."
Medical Implications of Isolation Protocol Failures
The failure to implement transmission-based precautions represents a fundamental breakdown in infection control that could have severe consequences in a nursing home setting. Respiratory infections spread through droplets when infected individuals cough, sneeze, or talk. In congregate care settings where residents often have compromised immune systems due to age and underlying health conditions, these droplets can rapidly transmit illness throughout the facility.
Standard medical protocol requires immediate implementation of droplet precautions when respiratory symptoms appear, not after test results confirm a specific pathogen. This preventive approach is crucial because the period between symptom onset and test result availability represents peak transmission risk. During this window, infected individuals are actively shedding virus particles while staff members provide close personal care without adequate protection.
The facility's own policies clearly outlined these requirements. Their influenza outbreak policy specified that "implementation of outbreak control measures can be considered as soon as possible when one or more residents have acute respiratory illness" and required droplet precautions for seven days after illness onset or until 24 hours after symptom resolution. The RSV policy similarly mandated that "transmission-based precautions, specifically droplet precautions, must be implemented when respiratory syncytial virus is suspected or confirmed."
Wound Care Violations Demonstrate Systemic Infection Control Failures
The inspection also documented serious breaches in basic hand hygiene during wound care procedures. During an observed treatment for Resident #31, who had both a Stage 3 pressure ulcer and a venous ulcer, Licensed Practical Nurse #1 repeatedly changed gloves without washing hands between procedures.
The nurse failed to perform hand hygiene after removing contaminated dressings, before applying new treatments, and between treating different wound sites. Most critically, the nurse touched a bottle of Dakin's solution (an antiseptic wound cleanser) with contaminated gloves, potentially spreading pathogens to equipment that other staff members would later handle.
These hand hygiene failures are particularly dangerous in wound care. Open wounds provide direct pathways for bacteria to enter the bloodstream, potentially causing sepsis - a life-threatening response to infection. Proper hand hygiene between glove changes prevents cross-contamination between wound sites and reduces the risk of introducing new pathogens into already compromised tissue.
Uncertified Staff Continued Providing Direct Care Beyond Legal Timeline
The facility also violated state regulations by allowing six nurse aide trainees to continue providing hands-on resident care beyond the 120-day limit established by law. State regulations permit facilities to employ nurse aide trainees in direct care roles for up to 120 days while they await certification testing. After this period, if certification has not been achieved, these employees must be reassigned to non-direct care positions or terminated.
Despite receiving notification from the New York State Department of Health on December 13, 2024, that the facility was banned from conducting nurse aide training for two years, six employees identified as Resident Assistants continued working in direct care roles past their 120-day eligibility period. The facility's Administrator acknowledged awareness of the requirement, stating that "nurse aide trainees who had not received their certification should have not been completing hands on care beyond their 120 days of hire."
This violation raises concerns about the quality and safety of care provided by inadequately trained staff. Certified nursing assistants must demonstrate competency in essential skills including infection control, safe transfer techniques, recognizing changes in resident condition, and emergency response procedures. Allowing uncertified individuals to continue providing care beyond the legal timeframe potentially exposes residents to increased risk of injury, inadequate care, and delayed recognition of medical emergencies.
Additional Issues Identified
The inspection revealed multiple interconnected failures in the facility's infection control and quality assurance systems. Staff members at various levels demonstrated confusion about basic protocols, with one nurse stating they were "unaware as to what the policy for influenza prevention stated." The facility's infection preventionist confirmed that residents with respiratory symptoms should have been placed on droplet precautions "as soon as their symptoms started," acknowledging this as "best practice" to "mitigate the spread."
The Regional Epidemiologist contacted during the investigation expressed concern about the facility's practices, noting it was troubling that nursing staff needed reminders about such fundamental infection control measures, stating that "residents experiencing respiratory symptoms and not placed on isolation precautions was concerning as that was how infection was spread."
Systemic Oversight Failures
These violations point to broader systemic issues within the facility's management structure. The Administrator, whose documented responsibilities included ensuring compliance with federal, state, and local regulations, failed to maintain adequate oversight of both human resources and clinical operations. The Regional Administrator confirmed that maintaining regulatory compliance was a fundamental expectation of facility leadership.
The inspection findings demonstrate failures at multiple organizational levels - from direct care staff who did not follow basic hand hygiene protocols, to nursing supervisors who failed to implement isolation precautions, to administrative leadership that allowed uncertified staff to continue providing care beyond legal limits. These cascading failures suggest inadequate training, supervision, and quality assurance processes throughout the facility's operations.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Houghton Rehabilitation & Nursing Center from 2025-05-02 including all violations, facility responses, and corrective action plans.
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