The facilities were fined by the state Department of Public Health (DPH) for violations that occurred between September 2019 and February 2020.

Skyview Rehab and Nursing of Wallingford was fined $10,000 after a resident with Alzheimer’s disease left the facility in January and was found dead about 50 feet from the facility, DPH said.

Staff noticed the resident was missing at 7:30 a.m. on Jan. 26, and the resident was found at 8:46 a.m., DPH reported. The resident was found wearing only a shirt and one sock, with bloody knees and muddy feet, according to the citation.

An investigation found the resident was last seen by a roommate on Jan. 25 between 9:30 and 10 p.m., and that staff hadn’t performed required regular two-hour visual check-ins with residents. A review of the facility’s staffing sheet showed there were only three nurse aides on duty, not the required four aides for the 11 p.m. to 7 a.m. shift, according to DPH.

A woman who answered the phone in the administration department declined to comment.

The Nathaniel Witherell nursing home in Greenwich was fined $10,000 after staff mistakenly let a resident with dementia leave the facility.

On Sept. 5, 2019, the resident, who wore a WanderGuard sensor, asked a receptionist for a ride home. The receptionist thought the resident was a visitor and called a taxi. The resident’s WanderGuard set off a door alarm as the resident left, but the receptionist claimed not to have heard it, and a housekeeper silenced the alarm without checking what triggered it or telling anyone, according to the citation. The resident returned by taxi about 15 minutes later, once staff realized a resident had left.

Following the incident, photos of all residents at risk for elopement were posted at the nurses’ stations and main reception area, according to the citation.

Groton Regency Center was fined $10,000 for several violations.

On Jan. 25, a resident suffered burns after falling out of bed and hitting a nearby baseboard radiator. According to DPH, the resident had a fever and was observed by a nurse aide as becoming increasingly restless that day, repeatedly trying to get out of bed. The aide failed to report the resident’s agitated behavior to a nurse supervisor. The resident was taken to a hospital and treated for leg burns and pneumonia. Following the incident, staff was re-educated and rooms were inspected to ensure beds were at safe distances from radiators, according to the citation.

On Feb. 13, a radiator was observed with its cover hanging down, exposing the heating element for more than an hour – during which time multiple staff who were in the room failed to report it, according to DPH. The cover exposed a sharp, jagged edge. Also, in one room there were only 18 inches between the bed and a wall, not the required three feet of clearance.

“Groton Regency Center is committed to providing high-quality care to our patients and residents,” said Lori Mayer, an administrator.  “Unfortunately, we did receive a Citation from the Department of Health earlier this year.  Since that time, we provided additional staff education and training, and submitted a plan of correction to the state.  At this time, we are in compliance with state and federal regulations.”

Orchard Grove Specialty Care in Uncasville was fined $9,480 after a resident was injured while being improperly transferred by a nurse aide.

On Sept. 14, 2019, an aide was moving a resident from a bed to a wheelchair when the resident suffered a leg laceration that needed nine sutures at a local hospital, DPH said. The resident’s care plan called for the assistance of two staff and a Sera (or sit-to-stand) lift for all transfers. At the time, the nurse aide was the only one working on that unit and was unaware of the resident’s care plan. The nurse aide tried to move the resident without assistance and without the lift, the citation said.

Salmon Brook Rehab and Nursing in Glastonbury was fined $6,120 after a medication error made on Aug. 14, 2019, sent a resident to the hospital with an overdose. A registered nurse was hurrying and mistakenly transcribed the resident’s dosage order for the antipsychotic medicine Zyprexa as 12.5 milligrams in the morning, 25 milligrams at night, and 12.5 milligrams every 12 hours as needed for agitation, according to DPH. The actual dosages prescribed for the resident were 1.25 milligrams in the morning, 2.5 milligrams in the evening, and 1.25 milligrams as needed.

Glendale Center in Naugatuck was fined $5,000 after an inspection on Feb. 4 found “pervasive significant” black mold on walls in the Dietary Department dish room, which was under renovation, according to DPH.

James Murphy, Glendale Center’s executive director, said workers discovered black mold behind a wall as they began a planned renovation project of the dish room. The facility notified DPH as a courtesy, and DPH inspectors visited and subsequently fined the facility, he said.  The renovation continued and the mold was removed.

Officials at the Nathaniel Witherell, Orchard Grove Specialty Care, and Salmon Brook Rehab and Nursing didn’t return calls seeking comment.

This story was updated from the previous version.

On May 6, Sharon Health Care Center was fined $2,320 in connection with two residents who were burned when they were served hot food, the citation from the state Department of Public Health said.

On Sept. 19, one resident was burned on the hand by hot pureed egg, the citation said. The resident was eating without help even though the care plan called for assistance during meals. The resident developed a blister that had to be treated, the citation said.

On Dec. 7, another resident was burned on a knuckle and developed a blister after touching food that was too hot, the citation said.

Staff members were re-trained so that they now serve pureed food last, allowing it to cool down, the citation said.

The chef manager told state inspectors that three heat control knobs had broken off the steam table in December, and the dietary director reported that the dietary staff had not been documenting the temperature of food before it was served.

Administrator John Horstman said the steam table has been fixed and the temperature of the food is monitored each day and logged before it is served.

“I don’t think this is a good reflection of who we are,” he said of the citation. “We’ve received many compliments from people who have done short-term rehabilitation here and from many residents with long-term stays.’’

On April 12, Glendale Center in Naugatuck was fined $1,635 in connection with a resident who broke a leg bone on Oct. 11, the citation said.

A nurse’s aide reported that the resident was being weighed when the scale moved and the person fell, sustaining a cut on the elbow and then complaining of knee pain, the citation said.

Jeanne Moore, a spokeswoman for Genesis Health Care, which owns Glendale Center, said the home is working closely with DPH and has provided additional education to its staff.

“Glendale Center is committed to providing quality care to its patients and residents,’’ she said.

Greenwich Woods Rehabilitation in Greenwich was fined $1,530 on April 20 in connection with a partially paralyzed resident who fell out of a wheelchair on Nov. 17 and was cut on the face.

The DPH citation said the resident’s foot got stuck under the wheelchair, causing the person to fall. The director of rehabilitation said the resident’s chair should have had leg rests on it to prevent falls, the citation said.

The home’s staff were re-trained to ensure that leg rests were on the resident’s wheelchair at all times, the citation said.

The home’s administrator, John Pasheluk, said that “we didn’t agree with many of the state’s findings” and the home entered into dispute resolution with DPH. He declined to say which findings the home has disputed.

On April 12, Marlborough Health Care Center was fined $630 in connection with a resident who gained 16 pounds in 20 days and was hospitalized with swelling and a worsening of congestive heart failure in October.

The resident recovered at the hospital and lost 12 pounds, the citation said. An advanced practice registered nurse said staff members should have informed the APRN about the weight gain so the resident could have been examined, the citation said.

Timothy Brown, a spokesman for the home’s parent company, National Health Care Associates, said the home is “confident that the issues raised in the report were isolated and not consistent with the care at our center. Clinical staff have been educated in the importance of documentation and retrained in policies and procedures.”

On Oct. 29, Sheriden Woods Health Care Center of Bristol was fined $1,580 when records show a resident with a venous ulcer on a toe did not get follow-up care with a vascular surgeon in September.  A doctor’s visit had been cancelled and records show a lack of follow-up care for a few weeks until a doctor saw the wound on Sept. 26.

Aurora Senior Living of Norwalk was fined $1,280 on Oct. 31 in connection with an incident on Sept. 22 in which a resident who needed assistance to use the toilet reported he or she was told by a nurse’s aide to “do it on” him or herself. The person soiled him or herself and it was later determined that two aides had taken their break together, resulting in inadequate staffing, DPH records show.

Glendale Center of Naugatuck was fined $1,160 on Sept. 4 in connection with a July 14 incident in which a resident sustained a cut on the head after partially falling out of a mechanical lift while being transferred into a wheelchair, DPH records show.

The resident’s head struck a bed frame during the transfer, and the cut needed six staples to close it, records show. An investigation determined that aides used the wrong type of pad during the lift and that the home’s records failed to be specific on what type of lift pad should be used.  The incident prompted the home to require that three staff members lift the person, records show.

Jeanne Moore, a Glendale Center spokesperson, said the home submitted a plan of correction to the state and is in full compliance with state and federal regulations.

“Glendale Center received a deficiency in a routine annual survey conducted at our center in August that resulted in a fine,” she said. “We provided additional staff education and training on the topic of lifts and transfers.”

DPH records show that on Oct. 28, Gardner Heights Health Care of Shelton was fined $1,090 in connection with a Sept. 16 incident in which a resident sustained a cut on the leg that required 18 stitches. The resident was cut while moving from a wheelchair to a toilet when a student nurse failed to follow the plan of care and assist the person using a gait belt, DPH records show.

Cassena Care of Norwalk was fined $360 on Oct. 29 in connection with a resident who broke a shinbone in February, apparently when one nurse’s aide, instead of the required two, transferred the person from a wheelchair to a bed using a mechanical lift. The nurse’s aide reported ringing a bell for assistance during the lift, but then admitted lifting the person without waiting for help, DPH records show.

Officials from the other four nursing homes did not respond to calls seeking comment.

“The CNAs were so afraid they were going to get in trouble if a patient fell,” Bolella recalled. “It took us almost a year to remove 33 alarms. I eventually had to lock up the alarms, so the staff would stop using them.”

In the two years that the nursing home has stopped using both alarms and restraints, it has seen a decline in the number of falls. Bolella isn’t surprised: “I never felt the alarms were effective.”

Kimberly Hall South is among a handful of nursing homes in Connecticut that have gone “alarm-free,” meaning residents at risk of injury, usually from falls, are no longer outfitted with detectors on their mattresses, chair pads and clothing that emit a warning signal when they try to get up and move around.

Alarms became a mainstay of the nursing home industry after the federal government cracked down on the use of physical restraints in the early 1990s. While most nursing homes still use alarms, in part to protect against state and federal penalties for inadequate fall-prevention measures, the move towards alarm-free facilities is growing in Connecticut, long-term care experts say.

“I think we have to ask, ‘What is the evidence base for the use of alarms to prevent falls and injuries?’ There really is none,” said Ann Spenard, a geriatrics specialist and vice president of operations for Qualidigm, the state’s Medicare quality-improvement agency, which convened a meeting on the topic this month. “They tell us a person’s probably already on the floor, or moving . . . While we’ve gone (away) from restraints, we’ve moved to the crutch of the alarm.”

The use of physical restraints in nursing homes has dropped dramatically in the past decade, with 121 of Connecticut’s 233 homes now restraint-free, Spenard said. Qualidigm is surveying homes to try to gauge how many have eliminated alarms, but Spenard said she believes it’s only a handful, to date.

That could change, as anecdotal evidence begins to show improvements in the rate of falls after eliminating alarms, Spenard said. According to one case study, at the Jewish Rehabilitation Center for the North Shore, in Massachusetts, the number of falls dropped 32 percent below the average quarterly fall rate after alarms were removed from a 45-bed unit.

Similarly, at Cheshire House Nursing and Rehabilitation Center in Waterbury, administrator Joanne Gorenstein reported a 15-percent decrease in falls after the home eliminated alarms more than a year ago. She said her decision to go alarm-free was prompted, in part, by an incident in which multiple alarms were sounding simultaneously, and “we were all running around, colliding with each other.”

Administrators of homes where alarms have been removed said that while the move requires new ways of monitoring at-risk patients, it also lowers anxiety for residents, especially those with cognitive problems, and for staff.

At Glendale Center in Naugatuck, long-term unit manager Doreen Lloret reported that patients in a 30-bed dementia unit who were agitated and restless are “much calmer” since the alarms were removed.

At Bethel Health Care Center, administrators asked residents how they felt about alarms before deciding to remove them.

“They find them intrusive. They say there’s a loss of dignity, “said Diane Judson, director of nursing at Bethel.

Spenard said that while it’s difficult for staff to deal with the cacophony of alarms, “Can you imagine if you can’t process all this information and distill it, how agitating it can be?” She noted that alarms in nursing home settings are counterintuitive.

“Alarms in real life tell us to take action. In the nursing home, they tell the resident not to move,” she said.

A study last year in the Annals of Internal Medicine that was based at a Tennessee hospital found that alarms did not statistically reduce fall rates. Spenard said there is also some evidence indicating that alarms may contribute to falls, because they disrupt residents’ sleep, making them tired and unsteady the next day.

But other experts say alarms are an important fall-prevention measure, especially for residents with dementia or poor safety awareness who may try to get out of bed at night unsupervised. The alarms remind the residents that they should not move, while also summoning staff to assist.

According to data from the U.S. Centers for Disease Control and Prevention, about 1,800 elderly nursing home residents die each year from injuries sustained in falls. Thousands more suffer serious injuries, such as broken hips. In Connecticut, nursing homes overall report that 3.1 percent of long-stay residents experience one or more falls with major injury, slightly lower than the national average.

Spenard and home administrators stressed the need for other interventions to prevent falls, if alarms are eliminated. They include frequent rounding, or checks, on residents who are at risk of falls; detailed assessments of residents’ needs, to identify when and why they get up and try to walk, including their toileting needs; and consistent assignments of nursing staff to particular patients.

“The whole thing is being proactive, not being reactive,” said Lloret. She said consistent assignments allow caregivers to get to know a resident’s schedule and “anticipate their needs.”

Some of the alarm-free homes have CNAs stationed in hallways or checking on high-risk patients at least once an hour. Spenard said understanding the underlying reasons why a resident might become agitated and restless – boredom or pain, for example — is critical, so that a care plan can be developed that might include music, activities or exercise.

Administrators of alarm-free homes said they educated families about the change and encountered little resistance. The buy-in from staff members was harder because of fears that falls would be blamed on them. Because the state Department of Public Health cites homes for lapses in care that lead to falls, removing alarms carries the risk of penalties.

Despite those risks, “It really is a sense of relief for your staff,” said Gorenstein. While nursing staff must be more diligent in monitoring patients, they no longer have to spend time adjusting and checking alarms. She said state inspectors have been supportive of an alarm-free environment, as long as other fall-prevention strategies are in place.

Lloret said the changes in residents’ moods are worth the risk. With alarms, residents were constantly being told to stop moving – not only by workers, but by fellow patients.

“How many times have you heard your staff say, ‘Charlie, sit down!’” she recounted at the recent meeting to discuss the use of restraints and alarms.

“Now, I want them to say, ‘Charlie, why are you standing? What do you need?’”