A Centerville nursing home has received a $15,000 fine from the Iowa Department of Inspection and Appeals, the department which regulates nursing homes in Iowa.
The Golden Age Nursing and Rehabilitation Center in Centerville was fined for the third time since June 2012 for the same offense: “failing to provide the minimum level of nursing care for its residents.”
Fines for a first class I or class II violations are capped by the state at $10,000 per violation. Subsequent citations for the same violation within a 12 month period can be doubled or tripled by the state. The recent citation resulted in a $5,000 fine that was tripled to $15,000.
The report stated that the nursing home “failed to provide nursing provisions with accurate assessment and timely interventions for two residents who experienced an adverse change in his/her physical condition.”
The recent report covers two deaths in November last year.
One resident, who the Des Moines Register has identified as 89-year-old Freda King, died on Nov. 29 at 7:50 a.m. The report states that King suffered a broken hip after falling at the home on Oct. 6. King was sent the hospital for treatment by her physician and returned to the nursing home on Oct. 26.
On Nov. 5, a staff member from the home found King on the floor of her room. The report states that the nurses notes from Nov. 5 at 10:30 p.m. from an LPN identified as “Staff H” said “the side rails were up on both sides of the bed. The resident did not know how he/she fell.”
The LPN notified King’s power of attorney and physician and King was transferred to an area emergency room for evaluation.
On Nov. 6 at 12:30 a.m., the emergency room, according to the report, contacted the facility nurse and stated the X-ray performed on King revealed no fractures and that the resident would be returned to the home. However, at 7:40 a.m. on the same day, King’s physician notified the nurse that the X-ray had been read incorrectly, and that King did indeed have a fractured left hip. She was transferred to an emergency room before being sent to a Des Moines hospital.
The report states that while at the Des Moines hospital, King had a myocardial infarction, or heart attack.
At the request of family, King was sent to the hospital on Nov. 24 at 9:11 p.m.
The report states that “The hospital admission history and physical dated 11/25/12 noted the resident had been admitted hypotensive with dementia, would open eyes to stimulation but could not communicate.” The resident also had a critically high sodium level and blood urea nitrogen level.
The report cites a hospital discharge summary, dated Nov. 29, as documenting that the resident had been rehydrated and had lowered sodium levels during hospitalization. The summary said King’s mental status improved but that she remained weak and malnourished.
The report stated, from the discharge summary, that “on the morning of 11/29/12 the resident developed a wide complex tachycardia with apparent ventricular tachycardia at 190 beats per minute. Resuscitation efforts were unsuccessful and the resident [died] at 7:50 a.m. on 11/29/12. The discharge summary listed the final diagnoses acute myocardia infarction, congestive heart failure, hypernatremia, dehydration and fractured hip.”
On Dec. 6, King’s physician stated that they were unaware King had not been eating or drinking and was showing a decreased mental status.
In a Dec. 5 interview, a CNA on the staff stated that prior to King’s first fall in October, she had been totally independent. After the fall, King began to be confused about using her call light.
In another case, a 91-year-old resident identified as Mable Stafford by the Des Moines Register died on Nov. 9 after being transferred from the home to the hospital.
The reports indicate that Stafford began having trouble breathing on Nov. 3. Her daughter, identified by the Des Moines Register has Paula Stafford, requested a change in medication. A nurse, according to the report, refused to notify the resident’s physician so a change of medication could be ordered. Paula then appealed to the director of nursing. The director made contact with the physician and a new medication was ordered.
On Nov. 5, Paula ordered for Mable to be transferred to the hospital after she found Mable gray in color and continuing to have trouble breathing.
When admitted to the emergency room on Nov. 5 at 9 a.m., the emergency room notes stated that “the resident arrived in severe respiratory distress with shallow, rapid respirations at 52 breaths per minute, and oxygen saturation at 91 percent on two liters/minute of oxygen… The resident showed decreased mental status, non-responsive to questions except with moans.”
The family notified Golden Age of Mable’s death on Nov. 9.
In a Dec. 6 interview, Mable’s physician “stated that the last condition update that she had received regarding [Mable] was on Oct. 29 that stated the resident had improved. The physician stated she had not been notified that the resident had been taken to the emergency room in respiratory distress” on Nov. 5, 2012.
Golden Age was last fined $8,000 in September for the death of 64-year-old Barbara Logsdon. The report in September alleged that the nursing home failed to provide timely interventions to relieve the resident’s respiratory distress, eventually causing her death.
Golden Age reportedly plans to appeal the latest fine.