By Justin Strawser

LEWISBURG — A Licensing Inspection Summary made public by the state Department of Health shows how Heritage Springs Memory Care in Lewisburg reacted to accusations of extensive elder abuse by members of its staff.

In a document on Aug. 4 detailing six violations, DHS reported that residents were sexually assaulted or harassed, verbally abused or teased and recorded on a cellphone in private moments at the facility located at 327 Farley Circle, Lewisburg. The actions were reported to “Staff Person D” — an unnamed fourth Staff member — who failed to make mandatory abuse reports to the Area Agency on Aging or DHS, as required under state regulations.

In the state report in response to the violations, Heritage Springs wrote that all staff members received job counseling and additional training, policies were updated or changed and the three Staff Members accused were immediately suspended.

After an internal investigation and interviews with all staff, Heritage Springs wrote that no other staff members admitted to having any knowledge of the alleged actions described in the report.

Download PDF

Two employees of Heritage Springs Memory Care were criminally accused last month of abusing elderly residents at the Union County facility between December and April. Madison Laine Cox, 18, of Pinchtown Road, Montgomery, and a 17-year-old male juvenile allegedly posed with patients in the shower or on the toilet, took pictures of patients who had defecated themselves or had fallen to the ground and took videos of themselves demeaning or harassing individuals, according to court documents filed by the Buffalo Valley Regional Police Department.

They allegedly sent those records to each other, shared them on the phone app SnapChat, and showed them to classmates at a school, police said.

The victims range in age from 72 to 100 years old. The majority of people residing at Heritage Springs are in various stages of Alzheimer’s disease or dementia, which limits or severely impedes their cognitive abilities, police said.

The state recently revoked the facility’s certificate of compliance and issued a provisional license, which is valid until Feb. 4, 2024. If the violations are not corrected within five calendar days of the receipt of the letter, the state intends to assess fines.

The Aug. 4 letter and report details a total of 30 violations stemming from licensing inspections on April 12, April 13, May 3, May 9, May 18, June 6, June 15 and June 27. Two additional inspection summary reports in February and December also showed a combined seven additional violations.

Heritage is licensed for a capacity of 64. At the time of its inspection, it was serving 30 residents ages 60 years and older and had a total daily staff of 60, according to the report.

Details in the report

The DHS report did not name any of the staff members or identify their age. The report lists the individuals as Staff Members A, B and C. DHS said “Staff Person A” is also an individual under 18 and “Staff Person B” still attends high school.

Staff Member A grabbed and patted a resident inappropriately on an unnamed body part and made “sexually inappropriate statements to a resident.” They would tease the resident until they became “very agitated and upset,” according to the report.

Interviews with staff also determined that Staff Members A, B and C were “making fun of residents and acting inappropriately toward them on multiple occasions,” the DHS reported. “Staff interviewers determined that these incidents were brought to the attention of Staff Person D, who failed to report them to the department, as required under this regulation.”

Staff Person A used their personal cellphone to take pictures and videos of 18 different residents at the home while working as a direct care staff person. These photos and videos were of residents in the nude and being showered/toileted. They also included a picture of a staff person pinching a resident’s nose, according to the DHS.

Staff Members A and B were “verbally abusive toward residents,” the DHS reported. “Residents were emotionally abused by Staff Person A and B through teasing and by Staff Person B by taking “a resident’s doll away, banging the doll’s head off a table and telling the resident, “You don’t think this is real, do you?”

Staff Person A also called a resident disgusting when they ate food. Staff Person A would also ignore residents when they were asked for things and would respond by saying “Bah, bah,” according to DHS.

That resident, according to Heritage, has a habit of spitting food out of their mouth when they are full or do not want to eat. This incident was not brought to the attention of management, according to Heritage.

Counseling and suspensions

According to Heritage’s response in the report, Staff Member A was counseled immediately when the resident care director learned third-hand about the patting of the resident. A discussion was held about the importance of being cautious with the way they talk and behave around residents as well as being mindful of taking jokes too far.

The three staff members have a “tendency to joke with residents to make them laugh,” according to Heritage. “A discussion was held with both staff members on (date redacted) stressing they must be cautious and there is a fine line that cannot be crossed. Behavior was addressed with both Staff Members A and B. At no time was any issue regarding Staff Member C brought to the attention of the Resident Care Director or Executive Director.”

Staff Person A was immediately suspended when the executive director was made aware of the incident with the cellphone by Buffalo Valley Regional Police Department, according to Heritage.

“An internal investigation was initiated by the executive director and supervisor, (and) business manager,” according to Heritage. “Interviews were conducted with all staff on (redacted date) and all were asked to write a statement as to any knowledge of inappropriate behavior or photos or videos being taken by any staff member. No staff member acknowledged that they were aware of behaviors or photos being taken. AAA and DHS were both notified immediately.”

Staff Persons B and C were also suspended. Staff Persons A and B will not be returning to Heritage Springs, according to Heritage.

All three staff persons denied any wrongdoing, according to Heritage.

Additional training

Additional training about residents’ rights, abuse training and mandatory reporting requirements was provided to employees. The importance of reporting alleged abuse was emphasized, according to Heritage.

One resident “is known for joking with staff and has been reminded multiple times to watch what they say and do to staff,” according to Heritage. “This resident is alert and orientated at times and has been redirected when” they make inappropriate comments to the staff.

Heritage claims that Staff Person D was never made aware of the comments that upset the resident.

“Immediately after we were notified, the executive director and business manager met with each staff member to see if any of them were aware of inappropriate behavior or photos/videos being taken and were asked to submit a written statement regarding any knowledge,” according to Heritage. “Not a single staff member acknowledged they were aware of any behaviors, photos or videos.”

Staff was also re-educated on the importance of reporting allegations to both their immediate supervisor and executive director immediately, residents’ rights, confidentiality and a revised cellphone policy. Staff each signed to acknowledge the fact they were reviewed, according to Heritage.

Under 18

A person who is 16 or 17 may not perform tasks related to medication administration, incontinence care, bathing or dressing residents without supervision, according to DHS.

“There is no direct supervisor from a qualified DCS (director care staff) person,” according to DHS.

Heritage claims that Staff Person A was “always under the direct supervision of a charge nurse or a med tech that was at least age 21. Staff Member A did partner with Staff Member B who was (redacted) years of age on occasions when performing care with residents under the knowledge of the shift supervisor.”

Policies changed

An internal decision was made to not hire those who have not graduated for any position other than dietary or activities, according to Heritage.

“Executive director will work alongside administrative assistant to ensure staff being hired as a caregiver are high school graduates or have their GED and are over the age of 18,” according to Heritage. “Executive director will audit all new employee files to ensure proper education was obtained and verified by receiving a high school diploma, GED or certificate of completion of certified nursing assistant programs.”

The cellphone policy was updated twice since the incident and all staff are now required to either keep their cellphone in their vehicles or in a locked storage cabinet near the time clock, according to Heritage.

A camera was placed in the time clock area to monitor use of cellphones and to ensure staff are following the revised policy.

The resident care director and executive director “conduct rounds to ensure cellphones are not in resident areas and policy is being enforced,” according to Heritage.

Heritage’s previous violations totaling nearly 30 included the following: Some staff members did not have up-to-date training or the required number of training hours; injuries resulting from residents falling were not reported in a timely manner; fire drill safety procedures were inadequate; numerous documents were missing key pieces of patient information; not having enough staff on specific shifts; paperwork was not properly completed; a new resident did not have a cognitive screening in a timely manner and a threat from one resident to another went unreported.

Upcoming court hearing

Cox has been charged with 17 misdemeanor counts of abuse of a care-dependent person.

The charges were filed by Buffalo Valley Regional Police Patrolman Gary V. Heckman in the Lewisburg office of District Judge Jeffrey Rowe.

Cox is scheduled for a preliminary hearing at 9 a.m. Aug. 24 in front of Rowe.

Attorney Erica C. Wilson, of Murray, Stone & Wilson, PLLC, in West Conshohocken, filed a lawsuit in Union County Court on behalf of patient Alice Longenberger and her family against the assisted living facility at 327 Farley Circle, Lewisburg, its management, building owners and two employees who were accused of abusing 17 residents. Those listed as defendants are Heritage Springs facility and corporation, administrator Tambra Speece, Business Manager Lennea Brown, employees Madison Laine Cox and a 17-year-old boy, property owner T-Ross Brothers, of Milton, and Todd and Tom Ross and Christopher Helmrich, of T-Ross.

The lawsuit alleges one count of negligence and one count of breach of fiduciary duty against the Heritage defendants; one count of negligence per se against all defendants; and one count of negligence and one count of battery against the two employees. A jury trial is demanded and judgment of at least $250,000 in damages is being sought, according to court documents.

Full Article & Source:
DHS report details elder abuse, response from Heritage Springs Memory Care in Lewisburg