Cleburne County Nursing Home is unable to accept more patients after two separate inspections found issues ranging from improper food storage to discontinuing medical treatment without a doctor’s order.
The first inspection, an annual recertification inspection, ended May 16. The inspectors found 10 different violations, most in the serious range, but three of the violations inspectors categorized as causing harm to the residents.
An inspection less than a month later generated by a complaint found four violations, three of which were initially categorized as causing immediate jeopardy. The three were later lowered to the serious category to allow the nursing home time to monitor and correct the situation.
After the first inspection, the Division of Health Care Facilities in the Department of Public Health notified Cleburne County Nursing Home administrators that after July 10 it would not receive Medicaid payments for new admissions.
That means the nursing home can’t take any new patients, Eura Harrell, nursing home administrator, said Thursday.
“We will not be able to admit until the state says we're back in compliance,” Harrell said.
As of Thursday afternoon, the 82-bed Cleburne County Nursing Home had 73 residents, which is about average, Harrell said. Nursing home occupancy usually fluctuates between 69 and 75, she said.
Harrell posted the non-admittance notice and the 50-page report on the recertificaton inspection inside the nursing home and notified all residents' emergency contacts that the nursing home was out of compliance, she said.
Harrell also notified members of the Cleburne County Hospital Board, which is the local board that oversees the nursing home, about the deficiencies at their meeting on May 20, days after the inspectors left.
"I'm not trying to hide anything," Harrell said Thursday.
Dr. Walter Geary is the bureau director and medical director for the State Survey Agency, part of the Alabama Department of Public Health, which oversees nursing homes in Alabama. Geary said the inspectors categorize infractions by letters: a, b, c being minor, d, e, f being serious, g, h, i, meaning actual harm was done and j, k, l meaning the actions placed residents in immediate jeopardy.
If a nursing home is found to have a minor violation, the inspectors let administrators know and ask them to correct it. No further action is necessary, Geary said. Anything d or above requires a corrective action plan and the nursing home has 90 days to correct the problems, he said. Anything j or above results in at least a fine and the nursing home has 23 days to correct the problem, he said.
The first inspection found 10 infractions: one in the minor category dealing with ice in the walk-in freezer, four in the serious category dealing with improper food storage, patient care and environmental hazards. Three of the deficiencies dealing with patient care including the treatment and prevention of bedsores and withholding treatment for pain, were found to have caused harm to patients.
Following that inspection, the nursing home submitted a plan of correction to the Alabama Department of Public Health to explain how it was going to fix the problems, she said. The department accepted that plan of corrections on June 30, Harrell said. Now, the nursing home is waiting for the state to come back to re-inspect, “hopefully in the next couple of weeks,” she said.
“We’ve done everything we can do now,” Harrell said.
The second inspection, on June 7, centered on a patient who was in the nursing home after hip surgery, according to the report filed by inspectors. The doctor ordered the patient's bandages be changed and the wound cleansed every other day. However, the treatment was changed without a doctor's order on April 29, eight days after the patient entered the nursing home. In addition, the staff performed other treatment including leaving the wound open to the air without documenting the treatment. The resident was subsequently hospitalized for infection in the wound and required more surgery and six weeks of intravenous antibiotics.
The inspectors' review of the incident found four deficiencies with the nursing home's treatment of the patient including standard of the care and records violations and failure of the administration to provide proper oversight.
Geary said if the nursing home cannot correct these deficiencies the Center for Medicare and Medicaid Services will cancel the contract with the nursing home and it will no longer be able to bill Medicaid for patient care.
"If you can't bill Medicaid, generally the nursing home has to close," Geary said.
The department has not yet done follow-up inspections for either of the initial inspections, Geary said.
Harrell said she was unsure when inspectors would return. The department doesn¹t tell nursing homes when to expect inspectors, she said.
Once the state comes back to inspect, inspectors may only check to make sure the deficiencies are corrected or they may doa full inspection, she said.
The state will notify her if the nursing home is back in compliance, Harrell said.
The final report after re-inspection will be posted on the Nursing Home Compare website, she said. She will talk to any concerned residents about the inspection results if they come to the nursing home Monday through Friday before 5 p.m., Harrell said.
Hospital Board member Pam Richardson said she found out about the ban on admissions not from Harrell, but when she saw the notice on the wall herself at the nursing home. She brought it up at the meeting in July which was rescheduled from its regular July 15 date to July 8, Richardson said Thursday.
Richardson said as a board member and as someone who has friends and family in the nursing home her goal is for each and every resident to receive “the utmost care” they are due.
“We have a wonderful nursing home,” Richardson said. “This is just an unfortunate time.”
The nursing home easily passed its recertification inspections about four years ago, with no deficiencies she said.
The Nursing Home Compare website shows that Cleburne County Nursing Home had one deficiency in 2013, two in 2012 and three in 2011. The average number of deficiencies for Alabama nursing homes in those years were 4.2, 4.4 and 4.2 respectively.