DAYVILLE, CT - State inspectors found that Westview Health Care Center operated for nearly five years without contracted behavioral health services while its official facility assessment continued to list a psychologist as an available resource, creating potential gaps in mental health care for vulnerable residents.
Outdated Assessment Creates Service Gaps
The Connecticut Department of Public Health investigation revealed that Westview Health Care Center's annual facility assessment, completed in October 2024, inaccurately represented the behavioral health services available to residents. The document listed mental health and behavioral services as part of the facility's offerings, including management of psychiatric symptoms, anxiety interventions, cognitive impairment care, depression treatment, trauma and PTSD support, and access to a contracted psychologist.
However, interviews with facility leadership revealed that these contracted behavioral health services had been discontinued in 2020, leaving a five-year gap between what the facility claimed to offer and what was actually available to residents.
The Advanced Practice Registered Nurse acknowledged during the inspection that "there had not been contracted behavioral health services since 2020." She explained that the Medical Director, a geriatrician, and she managed psychotropic medications and screening procedures, but neither provided psychotherapy services. When residents needed specialized mental health care, the facility's social worker was responsible for making outside referrals.
Medical Significance of Mental Health Services in Long-Term Care
Mental health services are critical components of comprehensive nursing home care, particularly given that studies indicate approximately 50-75% of nursing home residents experience some form of mental health condition, including depression, anxiety, or behavioral symptoms related to dementia.
Proper behavioral health services encompass several essential elements: medication management by qualified psychiatric practitioners, ongoing therapeutic counseling, behavioral intervention strategies, and crisis intervention protocols. When facilities lack these specialized services, residents may experience inadequate treatment of psychiatric conditions, potentially leading to worsening symptoms, increased behavioral issues, medication complications, and reduced quality of life.
The facility's approach of having the Medical Director manage psychiatric medications while relying on external referrals for therapy services creates potential coordination challenges. Effective mental health care requires integrated treatment where medication management and therapeutic interventions work together, with consistent communication between providers who understand the resident's complete clinical picture.
Facility Assessment Requirements and Compliance Standards
Federal regulations require nursing homes to conduct comprehensive facility assessments to determine what resources are necessary to provide competent care. These assessments must accurately reflect current capabilities and be updated when services change. The purpose is to ensure facilities can meet residents' needs both during routine operations and emergency situations.
Industry standards dictate that when a facility discontinues a service - particularly one as critical as behavioral health care - the facility assessment should be immediately updated to reflect this change. The assessment serves as a planning document that helps facilities identify gaps in services and develop strategies to address resident needs through alternative means.
In Westview's case, the failure to update the assessment for five years meant that care planning decisions, staffing considerations, and emergency preparedness protocols may have been based on inaccurate information about available resources. This disconnect between documented capabilities and actual services could impact the facility's ability to properly assess whether it can meet prospective residents' mental health needs.
Widespread Staff Training Deficiencies
The inspection also uncovered significant gaps in mandatory staff training completion across multiple critical areas. Documentation showed that 69 staff members failed to complete required communication education, while 61 staff members did not finish training in resident rights, abuse prevention, quality assurance, infection control, and compliance and ethics.
The training deficiencies were particularly concerning among nursing assistants, who provide the majority of direct resident care. Fifty-eight active nursing assistants failed to complete required competency training, while 49 completed zero percent of their assigned education through the facility's primary training platform. Additionally, 33 nursing assistants did not complete their mandatory 12-hour annual education requirement.
Most notably, the facility's Administrator failed to complete any mandatory training for 2024 and lacked access to the online education system used by other staff members. This represents a significant leadership gap, as administrators are responsible for ensuring facility-wide compliance with training requirements.
Impact on Care Quality and Safety
These training deficiencies create multiple risks for resident safety and care quality. Communication training is essential for staff to effectively interact with residents who may have cognitive impairments, hearing difficulties, or language barriers. Inadequate communication skills can lead to misunderstandings about resident needs, medication administration errors, and increased anxiety or behavioral issues among residents.
Resident rights training ensures staff understand and protect fundamental rights including dignity, privacy, choice in care decisions, and freedom from discrimination. When staff lack this knowledge, residents may experience violations of their basic rights or may not receive information about services and protections available to them.
Abuse prevention training is critically important given the vulnerability of nursing home residents. Staff who are not properly trained in recognizing, preventing, and reporting abuse may fail to identify concerning situations or may not know proper reporting procedures, potentially allowing harmful situations to continue.
Regulatory Response and Correction Requirements
The violations identified at Westview Health Care Center resulted in minimal harm citations, indicating that while problems existed, inspectors did not find evidence of actual resident harm. However, the facility must develop and implement a plan of correction to address these deficiencies.
For the facility assessment violation, the correction plan likely requires updating the assessment to accurately reflect current services, implementing procedures to ensure future changes are promptly documented, and establishing protocols for addressing behavioral health needs through appropriate referral systems.
Addressing the training deficiencies requires developing a comprehensive plan to ensure all staff complete mandatory education, implementing systems to track completion rates, and establishing accountability measures for supervisors and administrators. The facility must also ensure the Administrator gains access to required training resources and completes all outstanding education requirements.
Additional Issues Identified
The inspection narrative indicates additional violations were documented under tags F947 and F949, though the specific details of these citations were not included in the available documentation. These additional findings suggest the compliance issues at Westview Health Care Center extended beyond the facility assessment and training problems specifically detailed.
The combination of outdated facility assessments, discontinued services, and widespread training deficiencies points to systemic issues with the facility's compliance monitoring and quality assurance processes. Effective nursing home operations require robust systems to ensure regulatory requirements are met and that changes in services or capabilities are properly documented and communicated throughout the organization.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Westview Health Care Center from 2025-02-03 including all violations, facility responses, and corrective action plans.
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