Nursing homes ratings are high, show room for improvement

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By Jesse Osbourne

Springfield’s nursing homes are above average places for long-term care, according to ratings issued by Medicare.

However, inspection records show at least one of the area’s nursing homes was understaffed in 2010.
Records show that at least one resident at Springfield Nursing and Rehabilitation received only one shower during a two-month period. The records did indicate that the resident did receive bed baths in lieu of showers.
The ratings, which can be found at www.medicare.gov/NHCompare, rate Springfield Nursing and Rehabilitation with four stars out of a possible five stars.
The four-star quality rating is described as “above average.”
The data that determines the ratings, known as Quality Measure ratings, are submitted by the nursing home between Jan. 1, 2010 and Sept. 30, 2010.
Sansbury Care Center has a five-out-of-five star rating.
The rating is described as “much-above average,” according to the Medicare website.
The website outlines the last three inspections conducted at the nursing homes.
Also available to the public are more detailed results of those inspections, available through the Kentucky Office of Inspector General or by request at either nursing home.
Inspections can occur at anytime at a facility in a nine-to-15-month time period, according to Sansbury Care Center Administrator Darlene Herald.
Both nursing homes in Springfield have past inspections posted in a place easily viewed by the public.
Springfield Nursing and Rehab
The most recent inspection, completed in 2011, was deficiency-free.
“This is an accomplishment achieved by only 6.7 percent of skilled nursing centers in the state of Kentucky as of September 2011,” Holly Gould, executive director of consumer relations and communications for Extendicare Health Services, Inc., said.
Extendicare is the parent-company for Springfield Nursing and Rehabilitation.
Gould said the deficiency-free survey could move the facility’s rating to five stars once the Medicare website has been updated.
An inspection completed on Sept. 10, 2010 revealed that six health deficiencies occurred at Springfield Nursing and Rehabilitation.
Four of those deficiencies fell in the “quality care” category, while one fell in the “environmental” and “administration” categories.
Each of the deficiencies was assigned a harm level of two on a scale of one to four.
All reported deficiencies in the survey completed on that date were assigned as level-two deficiencies.  
A level-two deficiency, according to the “Federal Scope and Severity Grid,” causes minimal harm or potential for actual harm to the residents of the facility.
Corrective action plans for each deficiency are listed on the statement of deficiencies.
In the quality care category, the deficiencies included failure to “give professional services that follow each resident’s written care plan,” “give professional services that meet a professional standard of quality,” and “have enough nurses to care for every resident in a way that maximizes the resident’s well being.”
Of those four deficiencies, one revealed that one resident out of 15 sampled needed “mind stimulation activities,” and a sound machine designated for that resident was not being used consistently during the inspection.
Another revealed that physician’s orders for oxygen and oxygen monitoring for patients were not transcribed correctly for two out of 15 sampled residents, resulting in oxygen not being ordered in one case and oxygen saturation not being monitored in both.
Under the “failure to give professional services that meet a professional standard of quality” deficiency category, the inspection revealed that 11 observations over the course of two days indicated a resident, at-risk for bed sores, didn’t have his / her heels elevated off the bed as required by the resident’s ‘Plan of Care.’
In the category that gauges staffing levels, a problem with resident showers appeared consistent.
According to the statement of deficiencies, “nine out of 15 sampled residents failed to receive showers in accordance with the facilities shower list.”
Records indicated that Resident No. 4 only received one shower from July 12, 2010 through Sept. 9, 2010. The date of the shower was given was Aug. 7, 2010, according to the statement of deficiencies.
Resident No. 5  (as listed on the statement of deficiencies) was to receive two showers a week, but a review of the “Bath Type Detail Report” from July 11, 2010 through Sept. 9. 2010 showed that the resident was showered on July 14, July 24, July 31, Aug. 8, Aug. 11, Aug. 21, and Sept. 1 and Sept. 4.
An interview by the inspector with Resident No. 5’s spouse indicated that the response the facility gave regarding complaints about the showers was, “They don’t have enough staff today.”
Review of Resident No. 10’s daughter was also interviewed and told the inspector the facility did not have enough help and the facility was understaffed.
In an interview with the inspector, Resident No. 13 said he/she only received one shower a week most times because the facility just didn’t have enough help.
Resident No. 12’s shower schedule showed that a month went by without a shower between July 12, 2010 and Sept. 9, 2010.
An interview by the inspector with Certified Nursing Assistant (CNA) No. 7 showed that residents were to receive bed baths.
“Some patients have physical limitations that do not allow them to be showered,” Gould said. “In those instances, residents are given what is called at bed bath, which involves a thorough cleansing of the body and shampooing of their hair while they remain in bed. In some instances, residents do not wish to be showered and prefer to be given a bed bath. It is the resident’s right to decide whether they prefer a shower or a bed bath.”
Citing a heavy workload to the inspector, CNA No. 12 said, “I can’t always get it all finished.”
On interview by the inspector with CNA No. 8 indicated that residents didn’t receive showers when needed because of short staffing levels.
“Staffing levels fluctuate based on patient acuity and staffing patterns are reviewed daily to ensure that resident needs are being met appropriately,” Gould said. “We have reviewed our overall staffing levels and made some adjustments, which included adding some CNA positions. As evidenced by our November survey, where there were no deficiencies in this area, the state approves of this change.”
In the environmental deficiency category, the deficiency included failure to “have a program to keep infection from spreading.”
According to the statement of deficiencies, “the facility failed to maintain an infection control program to help prevent the development and transmission of disease and infection for one out of 15 sampled residents.”
The statement of deficiencies report stated that the facility had no signs to relate hand hygiene to visitors, family and residents.
A registered nurse was also observed entering a resident’s room without a gown or gloves, moving a table with bare hands and exiting the room without washing his/her hands.
In the administration deficiency category, the deficiency included failure to “keep accurate and appropriate medical records.”
This deficiency directly relates to the transcription errors regarding oxygen and oxygen saturation monitoring mentioned earlier in this story.
An inspection on Oct. 2, 2009 revealed zero health deficiencies.

Sansbury Care Center
An inspection on July 30, 2008 revealed seven health deficiencies, all with a level-two potential for harm.
“The center has a very strong record of regulatory compliance,” Gould said.
An inspection completed on Dec. 9, 2010 revealed that one health deficiency occurred at Sansbury Care Center.
The deficiency fell in the “nutrition and dietary” category.
The reported deficiency was a level-two deficiency on a scale of one to four.  
According to the Medicare website, “the inspectors determined that the nursing home failed to store, cook and give out food in a safe and clean way.”
During a tour of the kitchen, the inspector revealed two large cans of vegetables with dents in the sides of the cans, records state.
The inspector also found several food items in the freezer and walk-in refrigerator that were undated after taken out of the original boxes.
Also noted was a large bag of chocolate chips that had been opened and left open to the air, according to the report.
An inspection on Jan. 14, 2010 revealed five health deficiencies, all with a level-two potential for harm.
An inspection on Oct. 23, 2008 revealed nine health deficiencies, all with a level-two potential for harm.
According to the Medicare website, the average number of health deficiencies per facility in Kentucky is seven, and the average in the United States is eight per facility. The range of health deficiencies in Kentucky is 0 to 41.