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Cottonwood will be ready for next inspection, administrators say

Andy Bourelle

Cottonwood Care Center will be in substantial compliance with state regulations by Sept. 30, according to the facility’s administrators.

David Holmberg, administrator of Cottonwood, said the center sent a written plan of correction ) to the Nevada Bureau of Licensure and Certification Thursday, in response to the statement of deficiencies report from the bureau saying it still was not in substantial compliance with state regulations.

Cottonwood failed its annual licensure inspection in May, and the report was the result of a follow-up inspection done Aug. 11-15. A ban on admissions was placed after the first survey and will not be lifted until Cottonwood is considered to be in substantial compliance.

Cottonwood’s management is required to submit the correction plan, which must explain what the management would do to improve deficiencies and when the facility would be ready for another inspection.

Cottonwood’s plan of correction stated it would be ready by Sept. 30. Holmberg said he thought the center had been ready for the last inspection but improvements were being made daily to ensure the facility was in substantial compliance next time.

“We believe we were, and are, in substantial compliance,” Holmberg said. “Unfortunately, the survey team did not see it that way. That’s their call.

“We’ve been making progress daily. Now we have to make sure to exceed the minimum requirements.”

Holmberg’s company Premier Care Health Services took over Cottonwood after the first survey was done. Carson-Tahoe Hospital ran the center before and still works with Holmberg and Premier Care, subleasing the building, providing financial support and training nurse aids.

“I’m real impressed with Premier Care,” said Steve Smith, CEO of Carson-Tahoe Hospital. “If we’d had them two years ago, we wouldn’t be in this situation.”

Holmberg said Smith and the Carson-Tahoe Hospital administration and board of trustees have been supportive of Premier Care’s efforts to improve Cottonwood.

Cottonwood had made significant improvements from the first survey to the second, said Richard Panelli, acting chief of the Bureau of Licensure and Certification, but there were still important deficiencies such as meeting nutritional and rehabilitative needs of the residents.

If the correction plan is unacceptable the bureau will identify in writing what areas are not acceptable and give Cottonwood another time frame for another plan.

In most cases, Panelli said, deficiencies in a facility are taken care of by the first follow-up survey.

“It is the exception rather than the rule to go back to do multiple surveys,” he said.

The main problems Cottonwood faced as of the last survey, Panelli said, were system problems allowing deficiencies to exist. Using the example of an elderly woman cited in the deficiency statement who needed help feeding herself but wasn’t given assistance, Panelli said system problems caused this.

“That (the staff not assisting the woman to eat) is an individual issue. It’s an individual problem, and it’s serious,” he said. “But the facility has to make sure a system is in place so no one has to go through this. They need to provide an adequate quality of care for all.”

Holmberg and Cottonwood’s assistant administrator Michael Jacobs insist these system changes have been made.

“We’ve put in place all the systems you really need to have in a nursing home,” Holmberg said. “They were either not here before or were in place but not followed appropriately.”

Cottonwood has made numerous improvements, Jacobs said, including starting a weight loss intervention program and a restorative program for feeding training, and bowel and bladder training.

Holmberg said in addition to hiring Jacobs, the center has a new director of nursing, a new therapy company and several other new staff members. About 120 employees worked at Cottonwood when Premier Care took over, and only about 53 of those still work there.

The facility now has about 100 employees. The training and orientation of the new employees was a significant part of the improvement process, according to Holmberg.

He said the high staff turnover is typical when a new entity such as Premier Care comes in and raises standards.

“I’m extremely proud of what we’ve been able to accomplish,” Holmberg said. “We’ve got a core of good people here, and we’re building on that core. There’s continued progress – no question.”

The number of staff members would increase, according to Jacobs, when the ban on admissions was lifted and the facility had more residents. He said Cottonwood would be careful to make sure there was adequate staffing.

Cottonwood has a capacity of 125 residents.

The number of patients dropped from about 88 to 82 since the ban on admissions, Holmberg said.

“It (the number of patients) has not gone down rapidly,” Jacobs said, “another indication good care is being provided.”

Grace Menesini of Yerington, a care giver of one of the residents, comes to Cottonwood several times a week and said she is confident the facility is making the necessary improvements.

“They’re going to get things straightened out,” she said. “It was a mess when they took over. They can’t do everything overnight.”

Cottonwood could face serious problems from the Bureau of Licensure and Certification if its deficiencies are not corrected.

If a facility continues to be out of substantial compliance with regularity, Panelli said, the state could initiate action to revoke its license.

The surveys resulted in a 138-page report in May and a 60-page report in August, showing Cottonwood made significant progress in that time, according to Holmberg.

He said Cottonwood would be ready by the next survey.

“Our problem was that we should not have had the state back as soon as we did,” he said. “Maybe we should have made it 30 more days. Then there would not have been a question of significant compliance.”