The inspector found hole after hole in Resident 67’s care charts.
Staff tasked with cleansing and covering her thigh wound failed four times in January to document doing so. They missed recording a device’s blood oxygen readings 23 times over two months. They also failed to record blood glucose levels on 11 instances in one month.
In fact, the resident “revealed there were times when her blood sugars were not checked before she ate,” records state.
Resident 67 lived at Addison Heights Health and Rehabilitation Center in January when inspectors from the U.S. Centers for Medicare and Medicaid Services reviewed the nursing home. The individual — referred to only by number in federal inspection records — was among 16 individuals living at the facility identified as missing documentation for some type of treatment or check.
The Centers for Medicare and Medicaid Services regularly reviews nursing homes across the country, including 38 in Lucas County. A Blade review of federal records found violations of inadequate care and conditions at many facilities: missing or incomplete records; undocumented injuries; and poor resident hygiene.
‘Significant and grave concern’
Three area facilities had overall ratings of one star out of five, what the federal government calls “much below average.” There are 10 others with two stars, eight with three and four stars, and nine with five stars.
Facilities receiving the lowest overall mark are Addison Heights and Ridgewood Manor, both of Monclova Township, and Heartland-Holly Glen in West Toledo.
A prominent attorney in nursing home litigation, Nancy Iler of Cleveland, said one star suggests “significant and grave concern.” Such a mark merits further research, she said.
“It’s a very heart-wrenching decision to put your loved one in a nursing home. We should honor them by giving them care with dignity and the appropriate care, and hold nursing homes accountable for the care that they are not giving,” Ms. Iler said.
At Addison Heights, a federal statement of deficiencies and plan of correction report from January outlines a series of missteps by staff at the facility. One resident had a bandage on her right hand — she said from the nails of an unknown nurse aide grabbing her — but no one reported the injury upon treatment.
Another resident requiring hygiene assistance due to dementia had “whiskers on her chin” up to an inch long, survey records show.
“Her teeth appeared dry with plaque build-up and dark build up between all her upper teeth near the gum line,” a report states. “Her fingers and fingernails were soiled with black substance below each of the fingernails.”
Inspectors also found a medicine cart with expired medications, according to the records.
A reporter left several phone messages seeking nursing home comment and visited the facility to request an interview. Addison Heights officials did not reply.
Attempts to speak with residents at the facility were also unsuccessful.
Ridgewood Manor’s most recent report, from June of last year, criticized facility upkeep. A review of 35 rooms “all contained a build up of dirt, debris, and food items on the floor under beds, behind bed headboards, along walls at the base, in closets, and behind furniture.”
Inspectors found a soiled adult incontinence brief on the floor of one room between the bed and the wall, and on the floor of another room’s restroom. Some rooms also lacked privacy curtains.
Ridgewood hosted two residents, one 453 pounds and another 655 pounds, who shared a designated wheelchair.
“If either resident wanted to get out of bed on a day they are not scheduled for the specialized wheel chair they would not be able to,” the inspection report states.
A Ridgewood administrator declined The Blade’s interview request.
For Heartland-Holly Glen, a February inspection determined the facility did not promptly inform a neurosurgeon about a resident’s increased pain and change in surgical wound.
A nurse practitioner told a nurse to contact the neurosurgeon’s office about that pain. She returned for rounds three to five days later, asked about the resident, and learned the office was not contacted. They then immediately did so, reports show.
The resident required hospital admission for “surgical debridement of an infected wound, surgical removal of her prior surgical hardware, and excessive time spent with increased levels of pain,” the report found.
Holly Glen’s most recent standard health inspection, from May, 2017, noted gnats in the meal service room. Large amounts of gray, dust-like material also held to an air vent above the steam table.
“No documentation indicating the most recent cleaning of the air handling unit could be provided,” an inspection found.
In a statement, HCR ManorCare spokesman Kelly Kessler said the rating methodology is extremely complex and fluctuates based on an assessment at one point. The company operates Heartland-Holly Glen.
Heartland focuses on quality care for residents, she said.
“The issues that were found in the survey were immediately addressed, including in-service training for staff. Heartland is currently meeting state guidelines and are currently in compliance with regulations,” she said.
Quality of care
Thirteen of Lucas County’s assessed facilities, 34 percent, tallied one or two stars out of five. The rate falls in line with Ohio’s largest counties.
Half of Franklin County’s rated nursing homes were either one or two stars, followed by 37 percent in Hamilton, 35 percent in Summit, 34 percent in Cuyahoga, and 29 percent in Montgomery counties.
Ratings focus on three general metrics: health inspection results, staff, and quality measures. Those factors determine an overall rating.
Nine Lucas County facilities received five stars: Elizabeth Scott Community in Springfield Township, ProMedica Goerlich Center in Sylvania, Sunset Village in Sylvania Township, Little Sisters of the Poor and Orchard Villa in Oregon, and Ursuline Center, Ohio Living Swan Creek, Sunset House, and ProMedica Toledo Hospital Transitional Care Unit in Toledo.
High marks for these ProMedica facilities show a commitment to quality care, said Randy Schimmoeller, a senior vice president of operations at ProMedica.
“We continually evaluate our programs and services to ensure we are meeting not only the regulatory requirements, but also meeting the needs of the consumers,” Mr. Schimmoeller said. “It is important for us to focus on continuous improvement of our clinical programs.”
Pete Van Runkle, executive director of the Ohio Health Care Association, called the Centers for Medicare and Medicaid Services’ five-star rating system both publicly prominent and limited in scope.
“I just don’t think it’s guaranteed to be accurate 100 percent of the time, and there can be factors that come into play,” Mr. Van Runkle said. His association represents about a thousand such facilities and care providers.
Mr. Van Runkle said surveys are subjective and can be inadequate. A one-star rating is an indicator of concern, but greater evaluation is required. Many families facing crisis instead make a quick decision, he said.
A spokesman for the Centers for Medicare and Medicaid Services said the agency is dedicated to accurate and useful information. Standard inspections of facilities take place every year or so in addition to specific complaint inspections.
There are more than 60,000 inspections annually across roughly 15,600 nursing homes. Federal officials advise those considering nursing homes to visit, meet an administrator, and speak with residents.
Despite perception of nursing homes as solely for the elderly, these facilities also house younger residents. Some have medical disorders limiting their ability to live alone, or are recovering after surgery.
The authors of a 2016 Brookings Institution report, “Five-star ratings for sub-par service: Evidence of inflation in nursing home ratings,” called these ratings the industry’s gold standard.
Although certified inspectors conduct on-site checks, the nursing homes submit staffing and quality measures. The study notes nearly no correlation between inspection and self-reported results.
“The two self-reported domains can fundamentally change a nursing home’s overall rating,” the authors report.
In April, the rating system added new payroll-based data more accurately depicting staffing. Health inspections have always had the largest weight in star ratings, the federal spokesman said.
Ms. Iler said families pick nursing homes for a variety of reasons. Even a five-star rating is just one factor, however, and thorough research is necessary. It’s particularly important to review staffing levels from annual surveys, she said.
“Staffing goes hand in hand with good care,” Ms. Iler said.
Inspection reports can be found online at medicare.gov/nursinghomecompare.
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