The latest inspection of the state-run veterans nursing home in North Little Rock found 24 federal health and safety violations , the most state regulators have found in an annual inspection of the facility since it opened in 2017.
The survey, conducted last month, found that the Arkansas State Veterans Home at North Little Rock lacked a sufficient number of nurses to meet the supervision and care needs of the 85 residents, with both residents and staff members telling inspectors that the facility was short-staffed at times.
Other deficiencies that were cited included a failure to complete assessments of residents' care needs every three months, improper storage of food in refrigerators, a failure to conduct emergency drills and a failure to inspect fire-resistant doors annually in accordance with fire codes.
The inspectors with the state Department of Human Services' Office of Long Term Care also faulted the veterans home's response to a female resident's attacks against a male resident.
Scott Hardin, a spokesman for the state Department of Finance and Administration, said the home "immediately corrected the large majority of concerns contained in the survey" and submitted a corrective action plan that the Long Term Care office approved last week.
He said the survey took place as David Barker, who was hired as the home's administrator in March, was "early in the process of implementing new programs and scheduling and making new hires."
Those improvements have continued since the inspection was completed, Hardin said.
As of early last week, the home had 90 residents, and officials expect it to reach its capacity of 96 residents "within a matter of days," he said.
"Overall, we feel that the home is in a great position at this point," Hardin said.
Although the home is part of the Arkansas Department of Veterans Affairs, Gov. Asa Hutchinson last year tapped a Finance and Administration Department official to watch over it in relation to its financial troubles.
Like Hardin, Hutchinson spokesman J.R. Davis noted that the inspection took place early in Barker's tenure and just after the implementation of a new staffing schedule.
The governor is pleased with Barker's accomplishments, which have included increasing the number of residents by about 20%, Davis said.
"We've seen progress, and I think we'll continue to see progress," Davis said.
The previous administrator, Lindsey Clyburn, was asked to resign Dec. 31 after clashing with Veterans Affairs Deputy Director Chris Tafner, who accused Clyburn of mismanagement.
Martha Deaver, president of Arkansas Advocates for Nursing Home residents, said in an emailed statement that the 98-page report "describes serious violations of the law."
In addition to the shortcomings on food safety, health assessments and resident-violence investigations, she pointed to inspectors' findings that a resident had been allowed to give himself breathing treatments without a physician's order that said it was safe for the resident to administer his own medications.
In its corrective action plan, the home said it obtained the physician's order on June 17.
"The suffering that occurred because there was a blatant disregard for following the laws that are put in place to protect our veterans is a disgrace," Deaver said.
The first veterans home in the state built from the ground up for the sole purpose of serving former military members, the facility employs a "small-home design," consisting of eight, 12-resident cottages intended to minimize the institutional feel of a traditional nursing home.
The latest survey took place just a few months after the home was fined $96,000 by the federal Centers for Medicare and Medicaid Services as a result of a complaint inspection in January.
That inspection found deficiencies in the home's handling of complaints against a nurses' aide who was found to have verbally abused one resident in September and suspected in the possible physical abuse of another resident in January. It also faulted the home for letting a resident with Alzheimer's wander away from his cottage.
After the home agreed not to file a formal appeal, the federal agency reduced the fine to $63,059.75.
The home paid the fine earlier this month , Hardin said.
The violations found in that inspection and in the home's last annual inspection, in July last year, contributed to the home's being awarded just one out of five possible stars on the federal Medicare agency's Nursing Home Compare website, ranking the home as among the state's worst.
During the latest inspection, which did not result in fines, an inspector reported watching as a nurse's aide administered oxygen to a resident, who was short of breath, because a nurse was not available.
At a meeting with six residents on May 20, all "the residents complained about agency staff waking them up to give them the medications and then leaving the cottage," inspectors wrote.
"We believe there should be one nurse for one cottage," the inspectors quoted a resident as saying. "If there was an emergency, you would die before the nurses got to you."
Hardin said the inspection took place just after the home began assigning its licensed practical nurses to eight-hour shifts, with each nurse assigned to two homes.
Previously, the nurses had worked 12-hour shifts, with one assigned to each home.
Hardin said in an email that the new schedule provides "improved continuity of care as the same nurse remains assigned to the same cottages and residents versus the previous model in which a nurse may be off four days while working three."
"Maintaining one LPN for every two cottages is one component of the plan, but there is also a wide scope of care available through the remaining medical professionals on staff," including a nurse practitioner and six registered nurses, with unfilled openings for two additional registered nurses," Hardin said.
"As the home now significantly exceeds the required nursing hours per resident (state rules require 2.85 hours per resident each day and the NLR Home averages five hours per resident per day), we are confident moving forward with the new staffing model."
Hardin said the home has filled 14 of its 17 positions for licensed practical nurses and 81 of 92 positions for nurse's aides.
Examining the female resident's attacks on the male resident, the May inspection found that the home failed to meet federal requirements on investigating and reporting such attacks to the Long Term Care office and had not updated its policy on neglect and abuse to reflect the latest federal requirements.
The male resident in January told the home's staff that the woman hit him in the face with a newspaper for no apparent reason.
In March, the man said the same woman knocked his glasses off and hit him on top of the head with a plastic coat hanger.
"She comes in here all the time and bothers me," the man told an inspector, according to a report. "I just try to stay away from [her]. They just turn her loose in here, and she goes wherever she wants to."
The Office of Long Term Care, a part of the Human Service Department's Provider Services and Quality Assurance Division, conducts such inspections to ensure compliance with federal requirements by nursing homes that receive reimbursement from Medicare and Medicaid.
The home's last annual inspection, in July 2018, found eight violations, including five health violations and three fire-safety violations.
Including violations found during the complaint inspection in January, the home had nine health violations and three fire-safety violations during a one-year period ending May 31, according to the Nursing Home Compare website.
The state's other veterans home in Fayetteville had nine health violations and four fire-safety citations during the same period.
The average among all the state's 230 federally regulated nursing homes was 7.5 health violations and 1.9 fire safety citations during that year.
Information for this article was contributed by Hunter Field of the Arkansas Democrat-Gazette
https://www.arkansasonline.com/
NW News on 06/30/2019