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State gives nursing home last warning

Valley View Manor cited for 16 deficiencies by Colorado Department of Public Health

Paul Shockley
State health inspectors provided summary statements covering 16 different areas in which compliance is required to meet guidelines for Medicare and Medicaid programs. Jean-Marie Regan, public information officer with the agency's Health Facilities Division, said the complete125-page survey of Valley View Manor would soon be posted on the department's Web site found at http://www.cdphe.state.c.... Resident Assessment 1. "Based on record review, the facility failed to ensure that Minimum Data Set (MDS) assessments were either accurate or signed and certified as complete for 4 of 28 sample residents ...The failure to accurately and completely assess these residents created the potential for mismanagement of their care." 2. "Based on record review and staff interview the facility failed to develop comprehensive care plans for 7 of 28 sample residents that included measurable objectives and timetables to meet a resident's medical, nursing, and mental psychological needs that are identified in the comprehensive assessment." 3. "Based on record review and staff interview, the facility failed to follow professional nursing standards in implementing physician's orders and providing medications, monitoring, testing and/or treatments for 2 of 28 sample residents. The failure created the potential for mismanagement of the residents' conditions with unnecessary and/or avoidable illness or symptoms." 4. "Based on record reviews and staff interviews, the facility failed to maintain the previous 15 months of Minimum Data Sets (MDS) in 6 out of 28 sample residents' active records in a central location easily available to staff/physicians, creating the potential for clinical management to be impaired." Quality of Care 5. "Based on observations, resident/staff/family interviews, and record review, the facility failed to provide 3 of 28 sample residents with necessary nursing care and treatment." 6. "Based on observations, resident/family/staff interviews and record review, the facility failed to provide activities of daily living (ADL) assistance to 13 of 28 residents who were unable to carry out activities independently." 7. "Based on observations, record review, and staff interviews, the facility failed to ensure that 6 out of 24 sample residents did not develop pressure sores following admission to the facility or that those who entered with pressure sores received necessary treatment and services to promote healing." 8. "Based on record review and interview the facility failed to ensure that 3 of 28 sample residents received adequate supervision and assistance devices to prevent accidents." Nursing Services 9. "Based on observations, staff/family/resident interviews, and record review, the facility failed to ensure nursing staffing was sufficient, particularly on weekends, to 26 of 28 sample residents. Specifically, inadequate staffing was evidenced by: residents not being repositioned, with development of new pressure sores; residents not being toileted/changed; residents not being bathed, or provided with oral hygiene; residents not receiving adequate supervision at meals; residents' call lights not being answered in a timely manner; residents not receiving adequate assistance to prevent falls; residents receiving insulin and other medications late and residents running out of oxygen." 10. "Based on record review and staff interview, the facility failed to ensure that residents were seen by their physician at least every 60 days following the first 90 days of admission. This occurred for 2 of 28 sample residents." Infection Control 11. "Based on record review and staff interview, the facility failed to have an established infection control program. The facility failed to investigate, control, and prevent infections; decide what procedures should be applied to an individual resident; and maintain a record of incidents and corrective actions related to infections." Administration 12. "Based upon observations, record review and staff interviews conducted during an abbreviated survey and partial extended survey from 11-5-02 to 11-8-02, the facility failed to ensure it was administered in such a way as to utilize its resources effectively and efficiently in order to attain and maintain the highest practicable, psychosocial, mental, and physical well-being of each resident." 13. "Based on staff interview and record review, the facility failed to ensure that a staff member who worked as a nurse aide in excess of four months was determined to be competent to provide such duties." 14. "Based on staff interview and record review, the facility failed to maintain a complete and accurately documented medical record for one of 28 sample residents." 15. "Based on staff interviews and record review, the facility failed to train employees in emergency procedures and carry out unannounced staff drills using those procedures." 16. "Record review and staff interview revealed the facility failed to maintain an effective quality assurance (QA) committee which identified and addressed quality issues, and implemented corrective action plans."

Alleged lack of proper care, including a failure to meet the medical, nursing, and psychological needs of some of its residents, might mean Craig could lose its only nursing home, according to the Colorado Department of Public Health and Environment.

The possible shutdown of Valley View Manor, which would affect more than 50 residents who live at the home, looms as state officials wait for the facility’s administration to respond to a 125-page survey completed Nov. 8 by health department inspectors. The survey details 16 overall “deficiencies,” covering multiple care issues.

“The provider agreement will terminate unless the facility is found in compliance,” said Jean-Marie Regan, public information officer with the Health Facilities Division of the state agency.

Ending the provider agreement would mean the facility could no longer bill Medicare or Medicaid for services provided to eligible patients.

Regan said Valley View Manor’s administration has been notified of the survey and has 10 days after receiving the document to outline corrective steps, which the health department must also sign off on.

“We’ll also do a re-visit that will tell us whether they’re in compliance,” Regan said.

Re-visits as with the survey completed in November are unannounced, during which inspectors access records and the facility’s comprehensive care plans, interview residents, nursing staff and administration, Regan added.

November’s state report outlines 16 specific “deficiencies” found by inspectors. Among the charges are alleged inaccurate assessments of residents’ conditions; failure by staff and nurses to implement doctors’ orders and providing medication; inadequate oral hygiene and a lack of resident supervision to prevent accidents.

Nursing homes statewide receive unannounced inspections every nine to 15 months, Regan said. Of those, she said, facilities on average are cited for five to six deficiencies.

Valley View Manor has received three times as many deficiencies over the last year than the statewide average.

“In the last calendar year, about 10 percent had zero deficiencies,” Regan said.

At stake between Valley View Manor, which is owned by Atlanta-based Mariner Health Care, and its residents is the survival of Moffat County’s lone option for elderly care, said David Norman, regional director for the Area Agency on Aging, which supports the local Visiting Nurse Association’s long-term elderly care efforts with grant dollars.

Complaints and issues raised by Valley View Manor residents have filtered back to the Area Agency on Aging.

“It’s a problem that’s been ongoing,” said Norman, adding his organization in recent years has handled roughly 90 complaints per year regarding the facility from residents, or their relatives.

“I hope they can work things out. It’s a very troubling time,” Norman said, noting residents’ monthly payments to the facility run several thousands of dollars.

“I’d hate to think of moving those people around. They like having their families close, and you’d have to travel another 40 or 60 miles (to find the closest facilities offering similar care).”

Celia McConkey, who said she started in her position as Valley View Manor administrator in September, declined to comment on the state’s November survey.

Mariner Health Care’s Denver office referred all questions to a Texas-based public relations consultant, who emailed a prepared statement in response to questions.

“While we do not always agree with the positions taken by the surveyors during these inspections, we take the results of our most recent inspection seriously; and we have been working diligently to address the issues mentioned in the report,” according to a statement from Melody Chatelle, with Chatelle and Associates, which is based in Austin, Texas.

“We are proud to be a part of the Craig community; and we hope people will come and see for themselves the quality of care we strive to provide on a daily basis.”

Between April 2000 and February 2002, three unannounced health surveys at Valley View Manor produced 31 deficiencies, while it was twice denied payment for new admissions, according to online records with the Colorado Department of Public Health and Environment.

Among available penalties, the Center for Medicare and Medicaid Services or the Colorado Department of Health Care Policy and Financing may deny Medicare or Medicaid payments for new resident admissions, according to the health department’s Web site.

An inspection in February found 20 of the mostly “isolated” deficiencies, which also resulted in an unspecified monetary fine.

Unrelated complaint surveys completed by inspectors over the past three years show the facility was fined on three occasions for 28 separate deficiencies, while payment for new admissions has been denied on four different occasions.

“Mandates are made, it seems to be in compliance, and we seem to have problems again,” said Norman.

Dr. Larry Kipe, who has worked with residents at Valley View Manor for the past decade as the medical director, suggested the Craig facility is set in the state’s crosshairs.

The doctor insists he doesn’t know why.

“It irks me to no end how zealous the state has been in trying to destroy this building,” said Kipe, adding he’s paid four hours per month to work at Valley View.

“The government has some rules that doctors don’t agree with,” he said, citing past state inspector mandates to reduce, or temporarily suspend, a patients’ anti-psychotic medication.

“Doctors aren’t punished when they refuse to reduce medications, but the facility is,” Kipe said.

Inspectors also cited alleged incomplete treatment histories for patients, some of whom weren’t cared for by a physician within 60 day periods.

Kipe rejects this, insisting hand-written notes based on visits with patients sometimes remained at his private clinic.

Not, he conceded, where they belonged in their charts at Valley View.

“If it’s not in the chart, then it didn’t happen as far they’re concerned,” Kipe said.

“I don’t deny there is a track record (with Valley View), but I do deny that patients weren’t seen and cared for.”

Paul Shockley can be reached at 824-7031 to at pshockley@craigdailypress.com.


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