Federal authorities have imposed a $600,000 fine on Wanaque Center for Nursing and Rehabilitation in New Jersey following an adenovirus outbreak that has been linked to the death of eleven children.  The fine is a result of inspections of the Center that occurred during the outbreak in fall 2018.Investigators cited conditions posing “immediate jeopardy to children dependent on ventilators and other pediatric and elderly residents,” according to the report.  A letter from Lauren Reinertsen of the Centers for Medicare & Medicaid Services said the convictions were relevant to conditions that existed from Oct. 9, 2018, to November 16, 2018, but the center is now in compliance.  However, the Center still cannot admit pediatric ventilator patients pending state approval of infection-control protocol.  The center strongly disputes the report issued and is appealing.“Nothing in the report identifies systemic deficiencies in policies or procedures,” Rowena Bautista, Wanaque Center’s administrator, said. “There is no suggestion that the deficiencies identified contributed to the viral outbreak.  We already have addressed all issues raised by the Health Department and continue to cooperate.”

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However, Senator Joseph Vitale, chairman of the Senate Health Committee, said the deplorable conditions documented were “a disgrace.”  He added, “To be in an environment that’s that filthy, and it appears some employees were not responsive to patients’ needs — it’s not acceptable.  It’s awful.”  Vitale questioned how employees could allow such conditions to persist for so long, stating, “These are people who don’t have a voice for themselves.  It’s inexcusable.”The report detailed the experience of one adult patient at the center, whose age and gender have not been released, and who was living at the facility because of an unspecified “head injury, muscle weakness and a urinary tract infection.”  This patient was able to be interviewed by the inspector, who had checked the patient’s “incontinent brief” and found the individual was actually wearing two briefs that were “saturated with yellow urine.”  The nurse’s aide assigned to the patient’s care said she had been asked to change the diaper and had told the patient to eat breakfast first.  However, she admitted that she hadn’t checked for wetness during her morning rounds.The report also described two empty rooms that had gone days without “terminal cleaning.”  One room had been completely empty for ten days when inspectors noticed the open door on October 30.  Both patients who had previously occupied the room died after they were transferred to nearby hospitals.  They noted “personal items on a crib, an open bottle of saline solution, and trash in a garbage bin.”The door of the second room was closed.  It had been vacant for two days, according to the report.  Housekeeping managers told inspectors they “didn’t know the rooms needed terminal cleaning or that the patients had been discharged.”  The assistant director of nursing “could not explain it,” the report indicated.  However, the administrator said, “the delay in terminal cleaning…was because the family had not come to pick up the resident’s personal items.”Fifteen of 27 occupied rooms contained bed frames, ventilator carts, and heating units that had “accumulated rust-like substance.”  The upholstery of medical recliners known as geri chairs was torn and cracked, with foam and metal showing through in places.  “The center lacked a plan for preventive maintenance,” the report said.Following the November 14 visit, the state Health Commissioner, Dr. Shereef Elnahal, declared that the center posed “an imminent and serious risk of harm” to its residents.  He ordered it to halt admissions and to hire specialists in infection control and infectious diseases to eradicate an outbreak of the adenovirus.  This outbreak is thought to have caused the death nearly a dozen children.

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