March 24, 2000
St Francis nursing home cited for health,safety violations
By Malinda Ruble
Staff Writer
St. Francis Nursing Home has been cited by the Ohio Department of Health for health and safety violations concerning the residents. But St. Francis Home's attorney said things will change when the home's story is told.
In February, the Ohio Department of Health conducted an annual survey of the facility, finding conditions that "constitute immediate jeopardy to resident health or safety."
The surveyors cited violations of quality of care ranging from preventing accidents to infection control.
"The facility must ensure that each resident receives adequate supervision and assistance devices to prevent accidents. This requirement is not met. ..." the report stated.
The surveyor stated, "The facility failed to apply personal alarm devices as ordered by the physician or as indicated on plans of care for eight residents. Additionally, staff failed to correctly apply personal alarm devices to three residents so that the alarm would sound in order to elicit timely response by staff. Failure to apply assistance devices properly and as indicated placed these residents at risk for falls and serious injury."
One of the residents had refractured a shoulder.
"The resident had been heard to call for help and was found on the floor. The resident had attempted to transfer without assistance," the report stated.
The patient had a history of falls and nursing notes indicated staff reminded the resident to use the call bell for assistance, but the resident transferred without help.
"No further supervision or assistance devices were added to the resident's plan of care,'' the surveyor stated.
However, St. Francis Nursing Home's attorney, Geoffrey Webster, said the devices do not prevent falls.
"Residents obviously need to be encouraged to walk to receive positive benefits, but that introduces risk &emdash; that's normal. As you increase the level of activity and enjoyment of life, also you increase risk. We could stop everyone from falling down &emdash; we could tie them in bed, wouldn't that be terrible? The law prohibits that and the residents accept the risk when they walk,'' Webster said.
Webster said often residents refuse to wear the alarms.
"And the alarm goes off once they've fallen. It tells us something happened &emdash; not that something is about to happen. Sometimes things happen that can't be prevented,'' he said.
Following the findings of those patients in "immediate jeopardy," St. Francis Home submitted a plan of correction to correct those violations.
Other violations reported that the home will need to address included:
* Notification of rights and services where the home must notify the resident, physician, legal representative or family member when there is an accident or a significant change in the patient or treatment or a decision to transfer or discharge a patient. The facility failed to notify a physician of a patient's weight loss. Two of the 28 targeted patients suffered weight loss.
"There was a woman who weighed 100 pounds and who had cancer. A normal part of cancer is weight loss. She was consuming two times her caloric intake to her output, but she was still losing weight. If the state had been interested in seeing the full picture of the resident, they would have examined the paperwork. But the state thinks we should have done something about the weight loss,'' Webster said.
* Failed to make a comprehensive assessment of a resident's needs and ability to perform daily life functions. In one case of the 28 targeted residents, the "facility failed to appropriately assess pressure sores..."
"Some pressure sores are clinically unavoidable,'' said Webster.
In one case, the facility also failed to check a patient for incontinence.
"The pillow between her legs and the incontinent pad under her were observed to be wet ... the wetness spread until her dress was wet to the waist, half of the pillow was wet, and no dry area was visible on the incontinent pad," the state reported.
Webster said the patients are checked on a regular basis unless they notice sooner the patient needs to be changed.
"I know very well my children were clean and you would open a diaper and you could knock a buzzard off a poop wagon from 500 yards,'' he said. "Our level of skin break downs are extremely low, which would indicate if I'm doing nothing for incontinence, I would see extremely high levels of skin break downs."
* Failed to provide or obtain from an outside resource dental services to meet the needs of each patient.
* Failed to ensure that staff followed infection control procedures, including washing hands before and after cleaning patients, administering creams and giving medicine orally.
"Do the staff make mistakes? Heck yeah, they make mistakes. We try to prevent them with training. Our infection rate, produced by the facility's practices, is virtually non-existent," Webster responded.
* Failed to test all smoke detectors and to ensure complete coverage by the buildings sprinkler system.
"You know, stuff breaks &emdash; that happens. This building is used 24 hours a day, seven days a week. But we do have programs in place to review the facility,'' Webster said.
Webster said he will be requesting an appeal hearing on the citations, but no date has been scheduled.
The home has been under a fine of $5,400 a day since Feb. 16 until the violations are corrected or the hearing is completed.
"This is the first time I've seen anything like these (charges) in that facility. The state has wonderful goals, but it creates a facility that can't operate. I think when St. Francis gets its opportunity to tell its side of the story, there will be significant changes (in the findings),'' Webster said.
"For the families of the residents, any issues or concerns they might have they should bring it to the facility and come and look. Be sure the loved one is appropriately cared for and if they agree, I ask they support the facility,'' he said.