A small-town Eastern Shore nursing home where one-third of the residents have died this year has been ordered closed by the Maryland Health Department for licensing violations that "endanger both the health and safety" of the facility's patients.
Health inspectors cited Belle Haven Nursing Home in Hurlock, Md. for 82 state and federal violations, including unsanitary food service inadequate nursing supervision and dispensing medication to some patients without a physician's orders.
The home's owners denied many of the allegations and said they would appeal the decisions and said they would appeal the decision to shut down Belle Haven.
In one incident according to the state order closing the home medication was administered without a physician's order to a patient who died while using the drug.
Another resident died after Belle Haven's nursing director allegedly ignored the recommendation of a state registered nurse to have a physician examine what appeared to be a highly contagious staph infection in a patient officials said. The home's nursing director later claimed she had the infection examined, but state officials reported that they could find no evidence to support that claim.
Health department authorities did not contend that the alleged violations caused these or any other deaths. However, the death rate at Belle Haven was, by all accounts much higher than normal even among the 70 and 80-year-olds who make up most of the facility's residents. Eighteen of the 54 persons who entered the home this year died.
Harold Gordon, chief of the state agency that regulates nursing homes said his office is now trying to determine what factors contributed to the deaths. The condition at Belle Haven, he said, "is a threatening to patients as I've seen in seven years."
Emile Windsor administrator of the facility, sag the alleged violations "are minor or false. I don't think we're in any worse shape now than in the past."
Windsor said he plans to appeal the order to a health department hearing officer to defend himself against "a massive (accumulation) of minor intractions that just smothers you."
The 18 deaths at Belle Haven this year which is about twice the death rate in 1976 do not alarm him because "some years it's light and some years it's heavy."
Since 1962, Windsor, a former machinist disabled in an industrial accident and his wife Claribel, a licensed practical nurse, have operated Belle Haven as a homelike," 29-bed facility in this village on the edge of expansive farmlands northeast of Cambridge.
On the Eastern Shore, where nursing home beds are scarce the Windsors are known for working long and hard at their home almost as surrogate mother and fathe to their olderly charges, and for providing a personal kind of care said to be backing in some larner and more modern institutions.
The crazy facility surrounded by magnolia and spruce trees, a bird bath, flower trellises and tall hedges, is home to a variety of older persons in deteriorating states of health. Some have no relatives, while others have sons, daughters, nieces and nephews who cannot afford the time, money or private nurses to care for them.Some residents live there among longtime friends. Many sit starting absently into space.
Practically everything inside the old, rambling, wood-shingle building with its exposed heat and water pipes and chipped paint has a "drop of my blood on it," Claribel Windsor said proudly.
As for the state's order to close by Dec 2, the embittered administrtor said, "I'm too old to care now . . . I overfeed 'em. I overbathe 'em. I overspoil 'em, and my doctor said if I die and go to bell, those three sins will go with me." She broke into sobs.
"What hurts me," said Emile Windsor, "is that this makes this place look like a den of inquity . . . Maybe we aren't doing something right . . . But we've been doing what we thought was right all these years."
Until recently, Belle Haven was held in compliance with statelicensing regulations.Two weeks ago, health inspectors acting on a tip that the facility was riddled with problems spent five days surveying the facility.
The findings of six investigators were that the "genuine interest of the administrator in th ewelfare of the residents is questionable."
Mrs. Windsor, the health department said, was not carrying out her responsibilities as director nursing and had delegated many of her duties to an untrained "nursing supervisor."
The 15-page list of alleged offenses paints a picture of a nursing home where elderly residents sit idly for hours without supercision in surroundings furnished with rusty televiion-table trays.
Numerous problems were discovered in the nursing home's kitchen, where investigators said they found dirty appliances open trays of rodent bait flies on kitchen equipment and rusty, unlabled and swollen canned goods.
Frozen foods, including a six-pound tin of luncheon meat were kept unrefrigerated while one of the kitchen's freezers was being defrosted, the report said noting that the practice presented "a very hazardous situation."
During the inspection state investigators discovered what they considered a disturbing percentage of deaths at Belle Haven this year. Not only had one-third of the patients died - a rate that experts consider extraordinarily high for an intermeidate-care institution - but most of them had died at the nursing home rather than in a hospital.
In most cases administrators of similar facilities explained nurses immediately notify a doctor when a patient is believed to be acutely ill. If the illness is serious enough, the doctor will have the patient transferred immediately to a hospital that is equipped to treat acute medical ailments.
But prior to three deaths at Belle Haven during July and September inspectors said that such emergency procedures were implemented. In fact, the inspectors said they could find no phsician's orders for any medical treatment of the three patients who died.
The report said the patients' closest were cluttered and some patients' beds were not accessible to nurse alarms. Canisters of flammable butane were stored inside the facility and hot water temperatures in patient areas were "excessive."
As for the home's medication practices the report said patients who were supposed to receive drugs at certain times of the day had to wait sometimes more than two hours. Drugs were allegedly given before a doctor's orders were recorded and medications of former patients were stored in the medicine cabinet.
Belle Haven's medical records, the report said, "were so disorganized as to make meaningful evalutions impossible." The patient records did not include "pertinent nursing observations" since July, the report added.
Belle Haven provides 29 of the 580 beds in a region suffering from a shortage of intermediate care institutions. All the facilities have waiting lists. Belle Haven is one of several tht receives Medical reimbursement for a majority of its patients. The cost for Belle Haven residents is $690 a month.
Relatives of several Belle Haven patients praise the care their mothers, fathers, aunt and uncles were receiving at the institution and noted they even had seen outward signs of improvement in the patients while in the home.
"I thought their reputation was as good as it's ever been," said Jeanne Cook, director of the Dorchester County Department of Social Services.