Wanaque facility where seven children died from virus outbreak has been cited for deficiencies

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The long-term care facility in Wanaque where seven children died this month from a viral outbreak has been cited for several deficiencies in recent years that could lead to the spread of infection, according to government inspection reports.

The Wanaque Center for Nursing and Rehabilitation failed at times to properly supervise patients and handle medical equipment in a sanitary manner, according to four annual reports from 2015 to 2018. 

State Health Commissioner Dr. Shereef Elnahal said the deficiencies cited in the most recent report were "low-level" and have been corrected.

On Tuesday, the state Health Department announced that six children at the Wanaque facility had died this month and a dozen others were sickened as a result of a severe outbreak of adenovirus, a common virus that usually causes mild respiratory illnesses in otherwise healthy people. A seventh child died Tuesday night. 

The facility, on Ringwood Avenue, provides treatment for severely debilitated and medically fragile children, among other patients. The four inspection reportsand displayed  detail instances when nurses were not alerted when severely debilitated patients were in need. One patient broke a leg in a shower fall. Another struggled to clear his or her lungs. 

The management of the Wanaque Center did not respond to a request for comment Tuesday evening on the inspection reports. On Wednesday, staff members at the facility referred questions to Braithwaite Communications, a Philadelphia-based marketing agency whose services include crisis communication. The company did not respond to calls or emails. 

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Earlier on Tuesday, Rowena Bautista, the center's administrator, said “facility staff have diligently implemented all available infection control and prevention measures” to protect residents’ health and safety.  

Despite being cited by the government for 14 deficiencies over three years, the facility was rated above average by the federal government.

It was inspected four times as a result of complaints between Jan. 1, 2015, and Oct. 1, 2018, according to the state Health Department's website. But “no deficiencies were cited during this period."

But during annual routine inspections, health inspectors found problems.

The most recent routine inspection was conducted in August. Elnahal, the state health commissioner, said the deficiencies cited in that report had been resolved.

“We were last here before this past weekend in August, and there were a number of, again, low-level, self-limited deficiencies that they had to correct," he said at a news conference outside the Wanaque facility on Wednesday. "And they submitted a clear plan of correction, we accepted that plan, and when we came back here over the weekend, we checked each and every one of those and they had been resolved.”

He said the state would issue a final report on the most recent inspection, conducted Oct. 1, “soon enough.”

Assemblywoman Gabriela Mosquera, a Camden County Democrat who leads the women and children committee, said Wednesday that she was “appalled” to learn of the seven deaths and suggested that they likely were preventable.

"It’s very appalling to learn that the Health Department had already inspected this facility and had very poor results, meaning that they didn’t like a lot of the things they saw," she said.

August 2018

An inspection in August, posted below, showed instances of unsanitary practices that could lead to the spread of infection.

A nurse picked a pill off the floor and did not wash her hands before preparing to give more medication. In another patient, a urinary drainage bag had a hole in it and urine was collecting in a receptacle. A nurse told an inspector that “it happened frequently, supplies were not the best and a break in the closed urinary drainage system could lead to a potential infection.”

The report also said the facility “failed to provide a clean and homelike physical environment for their residents.” An inspector had smelled a strong odor of mildew in a patient sleeping area, the report said. 

Several staff members failed to correctly address the needs of patients, many of whom are so severely disabled that they cannot communicate, according to the report.

May 2017

The facility was cited for several practices that could lead to the spread of infection. 

• Nurses were observed not properly cleaning, drying and storing syringes used to give patients medicine orally.
• A nurse did not sanitize medication trays between sessions with patients.
• A scoop was left in a canister for amino acid powder, potentially exposing it to bacteria.
• Tubing from an oxygen tank that enters a patient’s nose was left exposed while the patient was receiving dialysis. It should have been placed in a plastic bag.
• A nurse did not properly clean the outside of a germicide container and a bottle of hand sanitizer after taking out a patient’s trash. The nurse was going to put them on a treatment cart before the inspector inquired.

In addition, an inspector cited the facility after observing one instance of poor patient care. 

• A non-verbal patient with cerebral palsy, seizure disorder and temperature instability was coughing loudly and trying to clear his or her airway of secretions. The inspector asked the patient’s teacher’s aide if she was going to tell nurses about the problem. The teacher’s aide then informed the nurses that the patient was “crying and stuff,” according to the report. The inspector tracked down the patient’s nurse and nursing supervisor, who told the teacher’s aide that they should have been informed to see if the patient needed to have his or her lungs suctioned. The teacher's aide said she didn’t inform the nurses because the patient “coughs and cries all the time,” the report said.

March 2016

The facility was cited for several deficiencies, including a shortage of nursing assistants for several days during one week in March, and a nurse who did not properly wash her hands while administering eye drops to a patient. 

The staff was also cited for a patient who broke a leg while showering. 

The patient was known to be at risk for falling because he or she suffered from severe seizures, spastic movements and obesity. The patient slipped off a shower chair in September 2015 while two nursing assistants were present. The team then decided to use a shower bed for the patient.

But in January 2016, the patient was allowed to stand in the shower, holding a rail. The patient’s legs gave way and a nursing assistant eased the resident to the floor. The fall was not reported to a nurse or supervisor to assess any injuries. The patient reported it, and an X-ray showed a fractured femur.

May 2015

The deficiencies cited by inspectors include: 

• The facility did not have care plans to send to other facilities for discharged patients.
• Faucets and fixtures in some residents' rooms were leaking or loose, or failed to completely turn off, and had excessive erosion. Some floors and toilet bowls were stained. Debris was found on heating and air conditioning units.
• A doctor interviewed and checked several patients with a stethoscope in public. They should have been examined in private.
• Staff members ignored some residents during activities, such as playing games or painting.

The reports follow below:

2015

2016

2017

2018

Staff Writer James Nash contributed to this story.