Local care centers cited for violations

Junior Katie Adler works with the elderly every chance she gets.

Adler volunteered at Twin Pines Adult Care Center in Kirksville to fulfill her clinical experience as a nursing student. She also works at a nursing home in her hometown of Kansas City, Mo.

There are four types of nursing home facilities: residential care, assisted living, immediate care and skilled nursing, according to the Missouri Department of Health and Senior Services. Residents in skilled nursing facilities usually need the most care, while residents in residential care facilities need the least amount of care.

Kirksville Manor Care Center and Twin Pines are both skilled nursing facilities, and Preferred Family Healthcare, Inc. is a residential care facility.

In her experience at Twin Pines, Continued from Page 1

Adler said the residents were content and autonomous for the most part, considering their physical and mental states. She said staff enthusiasm can help boost a resident's spirits.

"Staff is really good with communicating with the residents when they have a concern or a problem," Adler said.

The transition to working in a nursing home can be hard or frustrating at first because there are a lot of regulations and rules to follow, many residents require constant care, and the pay is low compared to the amount of work, she said.

"When they start to realize this is someone's dad or this is someone's grandpa, they start to personalize [the relationship] more and take better care of them," Adler said.

Despite this, the number of nursing home violations shows there is room for improvement in the operation of facilities.

Recent inspections show that Twin Pines had six health violations, and Kirksville Manor and Preferred Family Healthcare, Inc. had 13 health violations each. There are an average of eight violations per inspection both nationally and in Missouri, according to www.medicare.gov. Of the violations found in the three facilities, all of them were Class II except for five violations at Preferred Family, which were Class III.

All nursing home facilities are required to be inspected twice each fiscal year, according to DHSS. Facilities with Medicare and Medicaid certification through the federal government are subject to inspection once every 15 months.

Charisse Pappas, public information coordinator for DHSS, said it is the inspector's job to make sure a nursing home obeys the rules and regulations set forth by the state and federal governments.

"Each resident must receive the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being," Pappas said in an e-mail. "The facility must promote care for residents in a manner that maintains and enhances each resident's dignity and respect."

According to DHSS, the most common deficiency in Missouri nursing homes in 2007 was a failure of services to residents to meet professional standards. This deficiency refers to errors with medication or not following orders given by a resident's doctor.

Other common violations include inadequate care for residents who need daily living assistance, food sanitation deficiencies and disregard for the residents' dignity.

The majority of violations found at Twin Pines were because of deficiencies in quality of care, according to the report of its last inspection Dec. 29, 2006.

"The facility failed to assess one resident with a Foley catheter and a history of urinary tract infections in a timely manner," according to the inspection report.

In addition to the improper changing of Foley catheter and leg bags for one resident, the facility also failed to update another resident's wheelchair to prevent him or her from falling out of it and injuring himself or herself.

Both violations led to moderate harm and, in the first deficiency, prolonged discomfort.

Preferred Family was the only nursing home to have Class III violations, according to the report of its last inspection Dec. 7, 2006.

One such violation was because of the lack of a written procedure in the case of fire or any type of evacuation. This deficiency correlates with another violation in which a resident was left inside the building during an emergency fire evacuation. The inspection also revealed a failure in the facility to conduct one of 12 mandatory fire drills during 2006.

The same facility had a Class II violation involving one resident's case of being given Vicodin after a surgery even though the physician's written order said he or she was allergic to the drug.

The violations found at Kirksville Manor primarily were nutrition and dietary deficiencies and quality care deficiencies, according to the report of the most recent inspection Jan. 11.

"Based on observation and interview, the facility staff ... used ice for residents' water that had been used as a medium to cool stored food," according to the inspection report.

The inspection also revealed a violation of staff being respectful to a resident and failing to maintain the resident's dignity.

"A facility staff member [pushed] Resident #7 into the dining room, stopped near the first table, looked around the room, then in a loud voice asked, 'Is he/she a feeder now?'" according to the inspection report.

Karen Osborn, administrator of Kirksville Manor, said it is unfortunate when deficiencies occur, but people have to remember that the people working and living at the homes are human. She said the benefit of highlighting such violations is to reiterate specific areas where nursing homes need to change or improve.

Nursing home inspections are very impersonal, and inspectors often forget they are dealing with people and their homes, Osborn said.

"We feel like here we're trying to care for the resident on an individual-based need, and we're going to abide by all the regulations to the best we can," she said. "But [inspectors have] got to realize that they shouldn't take the human element out of it. In a long-term care setting, it is their home."