For the fourth time this year, state officials are investigating a Roanoke County nursing home that has already been cited for 45 deficiencies – the most for any such facility in Virginia.
Regulators with the Department of Health were at Richfield Recovery and Care Center last week to conduct an inspection, based in part on a complaint filed in October by a former employee of the nursing home.
Although the review could take weeks to complete, previous inspection reports, lawsuits and state disciplinary actions against nurses at Richfield provide a troubling track record of substantiated problems.
The current complaint alleges that elderly residents who are considered to be fall risks are often allowed to wander unattended from their rooms. Many of them fall and break their arms or hips, the complaint states, a problem that it attributes to staff shortages and an insufficient number of alarms to alert nurses when residents get out of bed.
Similar problems have been substantiated in earlier inspections and were raised in at least two lawsuits filed against Richfield.
So far this year, three inspections at Richfield have uncovered 45 deficiencies – well above the state average of 8.5 per year and the highest number this year for any nursing home in Virginia.
While most of the infractions were deemed to pose a minimal risk to only a few residents, one advocate for the elderly said the sheer number alone is cause for concern.
“There’s quite a lot to be concerned about with this facility,” said Norma McCroskey, assistant director of the Local Office on Aging, an independent organization with a mission that includes monitoring the welfare of nursing home residents.
Management changed
Officials at Richfield acknowledge past problems, but say they have been fixed.
“Yes, they did happen,” interim CEO Skip Zubrod said of the 45 deficiencies. “But there’s been a change in administration and things are moving forward.”
Zubrod took over earlier this year, and the nursing home has also hired a new administrator and a new director of nursing. Officials say the new leadership is already producing results, and that they expect only a few deficiencies from last week’s inspection.
Nursing homes in Virginia undergo routine inspections once a year as part of their certification process. Complaints are investigated separately, although sometimes they are included in the annual certification review.
So far this year, Richfield has been inspected four times. The first, in February, was the annual certification inspection. It found 33 deficiencies. Two more inspections, in April and May, revealed another 12.
The fourth inspection, conducted last week, combined the next certification review with an investigation of the former employee’s complaints. Results will not become public until later.
Richfield, which is the second largest nursing home in the Roanoke Valley, is operated by a locally-based nonprofit organization.
According to the former employee, life is not good inside the 315-bed nursing home, which is part of a campus-like Richfield Retirement Community that also includes independent and assisted living apartments near the western edge of Salem. The retirement units were not a part of the recent inspections.
“I would not put anyone that I loved in there,” the former employee said of the nursing home. “It’s beautiful on the outside, but inside, it’s terrible.”
2 lawsuits settled
Allegations from the former employee about lax supervision, and how it contributed to injuries to unattended residents who fell at the nursing home, remain unproven. However, similar assertions appear in court records and in previous inspection reports.
In 2012, Richfield agreed to settle a lawsuit filed by a woman who was diagnosed as a fall risk not long after she was admitted to the facility’s rehabilitation unit following a surgery. Although two staffers were supposed to assist her, only one was present to help her take a shower.
And when that attendant left the woman alone, the lawsuit stated, she fell and broke her right leg.
A second lawsuit involved the death of a Richfield resident in 2005. In that case, a 94-year-old man designated as a fall risk was not being properly supervised when he slipped from his wheelchair and tumbled down a flight of stairs, the lawsuit alleged. Avery Allen died in a hospital several days later.
Richfield also agreed to settle that lawsuit.
Lauren Ellerman, a Roanoke attorney whose firm handled both cases, said the litigation should have alerted officials at Richfield to a problem that needed immediate attention.
“Do I think the corporate entity should have been on notice that staff wasn’t following care plans and fall risk assessments, and residents were getting hurt? Yes,” Ellerman wrote in an email.
“Do I think they practically changed how they trained staff in light of these life threatening/ending injuries? No.”
In fact, the inspection in February found that Richfield failed to provide a working bed alarm – a pressure-activated device that alerts nurses when someone leaves their bed unsupervised – for a resident who was found making his way down a sidewalk in a wheelchair outside the building.
On a different occasion in January, a family member of the same resident found him lying on the floor of his room when she arrived to visit. After learning that the bed alarm was again not working, the relative asked that it be replaced.
“I was there for hours waiting,” the woman told inspectors. “I finally went to the nursing desk and told them I was going to stay all night if I had to, because I couldn’t leave him alone in the bed without an alarm.”
Jack Wood, the new administrator of the nursing home, said last week that the problems identified in the inspection have been corrected. He also disputed the former employee’s assertion that falls and injuries among unattended residents are a frequent occurrence at Richfield.
Many violations minor
Of the 45 violations of state regulations found at Richfield so far this year, all but a few were determined to pose a minimal harm, or risk of harm, to residents.
“This facility did indeed have the most number of deficiencies cited,” said Kathaleen Creegan-Tedeschi, director of the long-term care division of the Health Department’s office of licensure and certification.
“While the number of deficiencies cited is noteworthy, the scope and severity of each deficiency carries more significance,” she added.
One of the more serious violations involved the death of Ruth Dillon.
In March 2013, Dillon was transferred from a hospital to Richfield, where a tube inserted in her neck was used to dispense medications, fluids and nutrients.
When it was time to remove the tube, a nurse became confused and used the wrong procedure, causing severe complications. Dillon, 75, died several days later at Carilion Roanoke Memorial Hospital.
In March, Richfield agreed to pay $495,000 to settle a lawsuit brought by Dillon’s family, while denying any liability.
Another serious deficiency at the home documented in February was a failure to provide proper treatment to prevent bed sores that two residents developed.
Other violations of a less serious nature are detailed in inspection reports that go on for 31 pages in small, single-spaced print.
Among the findings: Some residents do not get their medications on time; staff failed to investigate an altercation between two roommates in which one was assaulted; dead bugs were found in light fixtures; hand rails in hallways were loose; at least one resident was not fed on time because of a staff shortage; and the rehabilitation unit’s kitchen was infested with rodents.
During an inspection of the kitchen, a Health Department official saw a large mouse scurry across the floor.
“Yeah, we are used to them here,” a staffer told the inspector. At one point, kitchen workers had to order extra-large mouse traps “because the mice were getting too well fed, and fat, to fit in regular traps,” the report stated.
Nursing board complaints
While state regulators have been making frequent visits to Richfield this year to inspect the facility, the Virginia Board of Nursing has also been receiving complaints about the staff.
From April 2013 to August of this year, the board held hearings to consider disciplinary actions against at least six nurses or nursing aides at Richfield.
Three nurses were exonerated. One was found to have been impaired by drugs while on duty. She was fired by Richfield but allowed by the Board of Nursing to keep her license if she completed a drug treatment program.
Another nurse was fired and had her license suspended by the state after an investigation found that she told a resident who needed a breathing treatment that she had more important things to do, laughing at the woman and making fun of her to other staffers. The nurse also told a co-worker attending to a different patient: “Can you please shut her the f— up.”
A third staffer, a nurse’s aide, was found by the Board of Nursing to have used excessive force. An order from the board stated that the nurse forced a resident to stand up by using her knee to separate the woman’s legs, causing her to urinate on herself. The nurse then called the resident “a pissy old thing.”
The aide was fired by Richfield officials and later had her license revoked by the state.
Despite the problems revealed by state regulators, Richfield officials say the vast majority of the employees work hard to provide quality care.
Several family members of people living at Richfield told inspectors they feel the staff is stretched too thin. The report quoted one relative as saying “the biggest problem at the facility was they did not have enough staff to care for the residents there.”
Deficiencies an ‘aberration’
After working as the administrator of Catawba Hospital, a state-run mental hospital in Roanoke County, Jack Wood moved to another facility in Eastern Virginia before coming back to the area to accept a position running Richfield’s nursing home.
He’s been on the job for about two months, part of an administrative shake-up that led to the replacement of the three top officials at Richfield this year.
Wood sees the recent inspections as an aberration.
Richfield had 11 deficiencies in 2013 and nine in 2012, numbers that are slightly above the state average. The way Wood sees it, the relationship between former Richfield administrators and state regulators might have fostered misunderstandings about the quality of care at the nursing home.
“It’s really a shame they had that [February] survey,” said Wood, who’s spent the last 23 years working in state and private facilities. “It’s not reflective of the quality of care we have. I wouldn’t be working here if it was.”
The former employee who filed the most recent complaint said she resigned under duress after pointing out problems.
“They like to get rid of the staff that report allegations or substandard care,” the woman wrote in her complaint. As a result, she said, there is “very high turnover of management and staff.”
The former staffer is named in the complaint, which she provided to The Roanoke Times. But she asked that she not be identified in this story because she is concerned that other facilities might be reluctant to hire someone who’s been labeled as a whistle-blower.
Meanwhile, concerns about Richfield linger in the minds of others.
McCroskey, of the Local Office on Aging, said her agency maintains close ties with most of the 19 nursing homes in the region it covers. The office gets more than a dozen calls a month from facilities with questions about how to best manage the day-to-day challenges of running a nursing home.
But officials at Richfield never call, McCroskey said.
“It makes me wonder,” she said. “Either they have it all together, or they don’t want us to know something.”