Nursing home is put on notice

A nursing home in Clemmons is facing federal and state claims that it isn't properly caring for residents after investigators said that a staff member injured a patient by picking her up out of a wheelchair and throwing her onto her bed.

Clemmons Nursing and Rehab Center has until June 19 to resolve the complaint by the federal Centers for Medicare & Medicaid Services or face termination of its provider agreement.

Such a decision would mean that Medicare would no longer make payments to the center for new inpatient services after that date. It would make payments for up to 30 days for patients admitted before June 19.

However, federal and state agencies have in the past extended the compliance deadline, depending primarily on whether the facility shows initiative in addressing deficiencies.

The nursing center, at 3905 Clemmons Road, is operated by Forsyth Health Investors LLC. The center has 120 beds and 71 residents, according to the website LocalNursingHomes.com.

The federal agency said in a legal notice filed yesterday in the Winston-Salem Journal that the center "is not in compliance with the requirements for participation" in Medicare and Medicaid.

The center also received a notice, dated June 1, that its state certification was in immediate jeopardy. That notice came from the Nursing Home Licensure and Certification section of the N.C. Division of Health Service Regulation.

Kamuina Badimu, the administrator of the center, and Forsyth Health Investors could not be reached for comment.

Bell Davis Pitt PA of Winston-Salem was listed as the agent for Forsyth Health Investors on the list of corporations on the N.C. Secretary of State's website. John Cocklereece Jr., an attorney for the law firm, said that he could not comment because he had not reviewed the legal notices.

The state's investigation cited concerns about residents' physical and mental health and said the nursing home failed to comply with its policies and procedures, such as filing timely reports on incidents.

The state said in its report that the female resident suffered a grapefruit-size bruise on her arm as the result of the rough handling by a female staff member on April 20. Another staff member saw the incident and reported it to a unit manager.

Afterward, the resident expressed fear that the center was not keeping the staff member away from her.

According to the report, the unit manager said she verbally told the nursing director about the incident.

On May 27, state investigators quoted the nursing director as saying, "I was not made aware of the alleged abuse, and I did not receive an incident report or statements of what happened." She added that she did not do any follow-up or investigate the allegation.

It is unclear, according to the report, whether the center has taken action against the staff member involved in the incident.

The center also was cited by the state for not properly observing residents' medication regimens and not properly cleaning some female residents' genitals.

The state agency recommended to Medicare that the center be fined a civil penalty of $10,000 for each incident. It said that even if the immediate jeopardy to certification is removed, the home's provider agreement still can be terminated in six months unless it has "achieved substantial compliance."

A survey by the federal Medicare and Medicaid agency, released in December, gave the center two out of five stars, with five being the highest. The rankings focus on three categories -- health inspections, staffing and quality measures.

Silas Creek Manor faced similar federal restrictions in 2002 and 2003, with its deficiencies being resolved in March 2003. As part of addressing the deficiencies, Silas Creek put performance-improvement plans and audits in place, as well as had top management changes.

rcraver@wsjournal.com | 727-7376

Journal Graphic by Nicholas Weir - Click to enlarge

Excerpts from the complaint report

"The administrator was notified of the I.J. on 5/27/10 at 1:20PM.

483.13(b), 483.13(b)(1)(i) FREE FROM ABUSE/INVOLUNTARY SECLUSION

The resident has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.
The facility must not use verbal, mental, sexual, or physical abuse, corporal punishment, or involuntary seclusion. This REQUIREMENT is not met as evidenced by:

Based on observations, resident and staff interviews and record review, the facility failed to protect and prevent further physical abuse and mental anguish for one 1 of 6 sampled residents who reported physical abuse that was witnessed by staff, resulting in (rough handling), mental anguish (increased fear).Resident #2.

The findings included:

Immediate Jeopardy began on 04/20/10. The facility administrator was notified of the Immediate Jeopardy on 5/27/10 at 1:20PM. The
immediate jeopardy remains ongoing until policies and procedures are implemented by the facility and could be reviewed and evaluated by the Quality Assurance committee. The facility was also in the process of ensuring the completion of employee training. The facility was in the process of ensuring the completion of the investigation." ---from page 5 of complaint report

"During an observation and interview on 5/26/10 at 11:55PM, Resident #2 was lying in bed with the blanket pulled up to her chest with clenched fist. Resident #2 stated, 'I am afraid because the staff that hurt me worked in my room the earlier part of the week. I don't know if she will come back and hurt me. Staff told me that she was fired, but I saw her earlier in the week and she came into my room, but I was scared to do anything so I just laid in the bed quiet as I could. I cried all night, hope this never happens to me again. I didn't know if she would come back and do something else to me. 'Resident #2 stated, 'She (a staff member) threw me in the bed and my arm hit the side rail. She held me so tight. 'Resident #2 was crying excessively with very wide eyes and a facial expression of fear.
Resident #2 requested that the accused staff not be brought to her room. Resident #2 was unable to give the name of the staff, but gave the description of the person as 'the big black lady with short hair. She did this to my arms on the side rail, I just wanted to go to the bathroom' (Resident #2 pulled up the blue sleeved top and pointed and showed the area that had faded bruising marks). Resident #2 stated, 'Please, please, please don't let that lady come back in my room. It will just upset me. I don't know what she will do. I won't be able to sleep. 'Resident #2 indicated that she was mistreated and scared. NA#1 came into the room and Resident #2 stated,'No, no, no that was not the lady that hurt me. 'Resident #2 continued to cry, grasp the blanket and began to slightly shake." ---from page 9 of complaint report

"During an observation on 5/27/10 at 2:20AM, Resident #2 was lying in bed with a scared fretful expression on her face, with the blanket clenched to her chest. Resident #2 re-stated what had happened to her by NA #11, by again describing NA#11 and stating that NA #11 had been in her room earlier in the week. Resident #2 began to cry and thought NA #11 was working the shift for 5/26/10. Her hands began to shake as she stated 2 times that she 'was afraid and that she (NA #11 by description) might hurt me and do it again.' Nurse #6 in a calm reassuring voice tone told Resident #2 that NA #11 was not working and the she was going to be safe for the evening. Resident #2 stated, 'Are you sure I'll be safe' and Nurse #6 stated, 'I'll make sure you will be safe' and the resident said ok and began to
calm down." ---from page 10 of complaint report

Choosing a nursing home

Here are some things to consider when choosing a nursing home:

• Plan ahead: Too often, decisions about care are made during a crisis. But planning ahead allows for better and less stressful decision-making.

• Decide what services are needed: There are many care and service options aside from the more intensive nursing home care. These include home health care, adult day care, adult care homes, and assisted living facilities.

• Ask for referrals: These may come from friends, relatives, doctors, religious organizations, social workers or state nursing home associations. The N.C. Division of Adult and Family Services has a website that offers information about local licensed facilities at www.dhhs.state.nc.us/aging/faq.htm. Another website,
LocalNursingHomes.com, lists local nursing homes that are Medicaid and Medicare certified.

• Ask questions: Once you have an initial list of facilities, ask if they are Medicaid and Medicare certified, if there are available beds, what type of care is offered, what is the typical resident profile, and what the admission requirements are.

• Take a tour: Visit the facilities you're considering and meet the staff. If possible, visit at different times of day to see what type of staffing there is and what activities are going on.

• Read the fine print: After you have selected your nursing home, be sure to read the contract carefully. It might be a good idea to have an attorney or ombudsman read it over before you sign.

• If you have a complaint: The N.C. Long Term Care Ombudsman Program investigates complaints. See www.ncdhhs.gov/aging/ombud/ombstaff.htm or call 919-733-8395.

The N.C. Division of Health Service Regulation also investigates complaints. Call 800-624-3004. There are also specialists within each county department of social services available to look into complaints and concerns.

Sources: N.C. Division of Aging and Adult Services, Forsyth County Department of Social Services