A nurse aide was fired from Maria Joseph Nursing and Rehabilitation Center after a dementia patient was found dead in a freezer in September, according to an Ohio Department of Health investigation.
Sofiya Perel, 86, was found dead several hours after staff had called 911 to say that she was missing.
A nurse told dispatchers “the alarm didn’t go off” and said they “don’t know how she got out.”
However, the new state inspection report filed with the health department shows a nurse aide deactivated the alarm after it went off, but failed to notify anyone or check to make sure each resident on the unit was accounted for. In an interview with state officials, the nurse aide said she assumed another nurse aide triggered the alarm.
“That is why she didn’t check the stairwell before silencing the alarm,” the report read.
The report showed the nursing home failed to report the incident to the state within the 24-hour window required by law.
The nursing home argued “the facility maintains that the alleged deficiencies do not individually or collectively jeopardize the health and safety of the residents,” the report read.
The report also showed that the cooler where Perel was found was not locked and a dietary worker failed to lock the kitchen door when they left for the night. It is not clear in the report if the dietary worker faced any disciplinary action.
Since the incident, padlocks have been put on the outside of the coolers and freezers. They require a key for entry, the report read.
Beginning the day after Perel was reported missing, staff began additional training on policies and procedures regarding incidents similar to Perel’s. They also underwent training to check on patients every two hours. The nursing home also did drills regarding potentially escaped patients.
At the time of Perel’s death, the Maria Joseph’s officials said they were “very saddened by the loss of one of our residents. We are, on all levels, assisting in the investigation of this tragic incident. We continuously strive to ensure the safety of the residents in our care.”