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Nursing home gets substandard rating

by Christy Chalmers

The state has again declared the Valley Meadows Living Center substandard, another admissions ban is looming and the facility’s administrator recently resigned, but the nursing director says the issues have been addressed and it’s “business as usual.”

The resignation of administrator Jim Heinzen coincided with the release of a 122-page report by the state Bureau of Licensure and Certification. The report details results of a follow-up inspection conducted in October at the Gardnerville Ranchos nursing home.

Heinzen, who had been administrator since December 1997, did not return messages left at his home in the Gardnerville Ranchos. Bonnie Carver, director of nursing for Valley Meadows, said she did not know Heinzen’s reason for leaving.

State officials released a copy of their report to The Record-Courier Friday. Though the inspection occurred a month ago, state regulations delay public release of such reports until the subject facilities have a chance to respond.

The report says Valley Meadows was substandard in the areas of patient weights and bowel care, but also lists myriad problems such as reports of inadequate staffing that resulted in patients being denied or forced to wait for personal attention.

Carver acknowledged the findings but said corrections have been made.

“We have corrected the issues and no residents were in harm or jeopardy, and it’s business as usual,” she said. “We do have adequate staffing to handle the needs of the residents.”

Carver said she and three employees comprise a board of directors that is running the facility while a new administrator is sought. Calls to Cleveland, Ohio-based Multi-Care Management, which now owns the facility, were not returned.

n $500 fine. Health Facility Surveyor Diane Allen, who supervises the state’s Carson City office, said Valley Meadows has been subject to a $500-per-day fine since July 29, when an annual inspection was conducted. The October inspection was a follow-up to the July visit.

Allen said Valley Meadows will face a ban on admitting new Medicare patients effective Nov. 19. She said the bureau will likely do another inspection Dec. 10 and the facility has until January to correct the problems before further sanctions, such as closing it, are considered.

Allen said the substandard care definition translates to an absence of systems to assess the weight and bowel care issues.

“If it was very serious, we would have called out immediate jeopardy,” meaning the center could have been shut down within 23 days, said Allen.

Still, she added, “Substandard quality of care is not common in Nevada.”

n Unannounced visits. Pending the Dec. 10 reinspection, Allen said the state is monitoring Valley Meadows with unannounced visits “just to make sure the conditions haven’t gotten any worse.”

The center currently has 75 residents and room for 125. Carver said she did not know how many nurses the facility currently employs, and said there is no specific patient-to-nurse ratio because the staff required depends on the needs of the patients.

The state report lists several requirements that Valley Meadows did not meet during the inspection, conducted Oct. 7, 8, 11 and 12. The two main areas – weights and bowel care – involve documenting and treating unexpected gains and losses in body weights and ensuring patients have regular bowel movements.

But problems were investigated in 17 other areas, ranging from administration to the quality of the residents’ lives. Some residents told inspectors of long waits for assistance, and surveyors documented incidents in which patients were denied showers and other personal care. The report cited facility records indicating some residents went several days between showers, and at least one instance in which denial of a shower was attributed to a lack of staff.

Other criticisms involved incorrect administration of medications, both by residents and nurses; failure to assess and implement care plans for some residents; poor record keeping; and environmental problems involving odors and flies.

The report blasts the facility’s administrators for failing to approve or implement various policies, as well as not providing enough yearly training for its certified nursing assistants.

“Based on interview of staff, review of written policies and procedures and review of investigations of alleged abuse, it was determined that the policies and procedures of the facility failed to reflect the intent of the regulation and the facility failed to implement the policies and procedures that were written,” part of the final statement in the report concludes. “The facility failed to implement their own policies and procedures. There was no evidence that all of the allegations were thoroughly investigated. There was evidence in the record that not all of the allegations of abusive behaviors had been reported immediately to administration for appropriate action.”

The critical report is not the first issued for Valley Meadows. Formerly known as Cottonwood Care Center, the facility was the target of a state ban on admissions in May 1997 after failing an annual inspection. The ban was lifted in October 1997.

n Lawsuits. Three lawsuits alleging negligence of former residents were filed between 1996 and May 1998, and an attorney has been looking for other possible plaintiffs.

The facility has also experienced a variety of management changes. Carson-Tahoe Hospital bought the center in 1995, but hospital officials leased it to private operators in August 1997 after they couldn’t turn a profit.

The private operator, Arizona-based Premier Care Services, defaulted on a $1 million hospital loan and the facility, by then known as Valley Meadows, went into receivership in October 1998.

The center’s employees ran Valley Meadows from April of this year until October, when a Cleveland, Ohio-based firm called Multi-Care Management took over. At the time the Multi-Care deal was announced, chief operating officer George Repchick cited the center’s employees and a “special atmosphere” they created. He said the company anticipated expanding its holdings, and Nevada appeared to be a strong and growing area.