‘Help me’: Iowa nursing home that’s among the nation’s worst faces no state fines

By: - July 14, 2021 1:23 pm
Illustration of flag, stethescope, money

The owners of a Sioux City nursing home have yet to pay all of the fines they were hit with in 2019 and are facing no state fines as a result of the new violations. (Photo by Bermix Studio via Unsplash)

A Sioux City nursing home where workers have allegedly ignored residents’ cries for help and waited 40 minutes to perform CPR on a resident with no pulse has been added to the list of the nation’s worst nursing homes.

Although the owners of Countryside Healthcare Center of Sioux City are being cited for numerous, serious violations related to resident injuries and at least one death, they have yet to pay all of the fines they were hit with in 2019 and are facing no state fines as a result of the most recent violations.

The home is now one of 10 Iowa care facilities eligible for inclusion on the Centers for Medicare and Medicaid Services’ Special-Focus Facility List, which is a national list of homes with some of the worst records of regulatory compliance.

Countryside is home to roughly 33 people and is owned by 6120 Morningside Avenue Propco, a New York-based real estate company.

In March, state inspectors visited the facility in response to 12 complaints. Two of the complaints were tied to self-reported incidents at the home, and 11 of them were verified by the Iowa Department of Inspections and Appeals. The inspectors produced a 99-page list is deficiencies at the home and cited the owners for 23 separate violations of federal nursing home regulations.

DIA suggested a state fine of $18,500 was warranted, but held that fine in suspension to let federal officials impose their own penalty. However, state and federal records indicate Countryside’s most recent federal fine was imposed in August 2019, for $27,115. The facility’s owners have yet to pay $9,490 of that fine, according to DIA records.

Among the violations state inspectors say they found in March:

  • A medication aide at the home told inspectors that on Dec. 12, 2020, he looked in on a COVID-19 patient and the resident appeared happy and smiling, with no concerns. Two hours later, the aide said, he saw the director of nursing emerge from the resident’s room, saying the resident was dead. About 10 or 15 minutes later, the aide said, he went into the resident’s room and the director of nursing asked him what she should do because the resident’s status was “full code,” indicating CPR should be attempted. After another 30 minutes passed, a third worker arrived on the scene, initiated CPR and summoned an ambulance. The resident could not be revived. The director of nursing later told inspectors she had waited only a “few minutes” to initiate CPR. The home’s administrator told inspectors the director of nursing was fired after the incident.
  • While inspectors watched, a female resident hollered “help me” and “hurry up” from her bed on the morning of March 23. The door to the resident’s room was closed, inspectors said, but the hollering could be heard at the nurses’ station down the hall. Twenty-three minutes later, a nurse arrived, pushing a medication cart down a nearby hallway. Although the resident continued to call for help, the nurse did not stop to check on the woman. The resident continued to call for help until 47 minutes had passed and two workers entered her room.
  • A male resident of the home reported that he had twice summoned a nurse to his room to empty his urinal so he could relieve himself. In both instances, the worker refused and the man eventually soiled himself, later telling inspectors he felt belittled and ashamed.
  • The home failed to notify residents’ physicians of significant unexpected weight loss, with one resident dropping from 163 pounds to 146 pounds in 30 days.
  • The home employed a nurse aide with convictions for theft and assault without having the worker cleared for employment by the state.
  • Inspectors reviewed five patient files and found that in all five cases, the home failed to ensure a physician saw the resident at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. Some residents had not been seen by a doctor for six months. A nurse practitioner who was the acting physician for five residents told inspectors she had not been to the facility for eight months and that her office tried several times to schedule a time for her to make rounds there but no one returned her calls.
  • The home failed to answer call lights in a timely fashion, with residents saying they waited 40 minutes to an hour for someone to respond. While inspectors watched, the call lights for three residents remained on at the nurses’ station more than 15 minutes as four nurses stood by. “None of the staff attempted to respond,” the inspectors reported. The next day, an inspector noticed that one resident’s call light had been on at the nurse’s station for 46 minutes. At the time, three nurse aides were standing at the nurses’ station talking, the inspector reported.
  • The home was also cited for failing to follow professional standards of care for the administration of medication and treatment; failing to monitor a diabetic resident’s blood sugar, resulting in the resident being rushed by ambulance to a hospital; failing to provide complete and appropriate care for incontinent residents; failing to prevent and treat bed sores; failing to maintain residents’ nutritional status; failing to ensure that newly hired nurse aides were properly certified; failing to practice effective infection control; failing to maintain a clean kitchen while failing to serve food at a safe temperature; and failing to have sufficient, qualified nursing staff available at all times.

The Special-Focus Facility List is updated quarterly by CMS and includes homes deemed by CMS to have “a history of serious quality issues.” Those homes are enrolled in a special program intended to stimulate improvements in their quality of care through increased oversight.

Nationally, the number of facilities on the list remains relatively constant: There are normally about 88 nursing facilities, with one or two slots to be filled by each state. The Iowa Department of Inspections and Appeals nominates the Iowa facilities for inclusion on the list, and CMS selects two from the state to be enrolled in the program.

In addition to Iowa’s two special-focus facilities, there are 10 Iowa homes that qualify for inclusion on the list based on their poor performance. But in order for any of those 10 to be designated a special-focus facility and receive the added regulatory oversight that comes with it, one of the two currently designated homes first must graduate from the list, which can take four years or more. Countryside is now among the 10 Iowa homes eligible for special-focus oversight.

Typically, homes that are eligible for special-focus designation have about twice the average number of violations cited by state inspectors; they have more serious problems than most other nursing homes, including harm or injury to residents; and they have established a pattern of serious problems that has persisted over a long period of time.

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Clark Kauffman
Clark Kauffman

Deputy Editor Clark Kauffman has worked during the past 30 years as both an investigative reporter and editorial writer at two of Iowa’s largest newspapers, the Des Moines Register and the Quad-City Times. He has won numerous state and national awards for reporting and editorial writing. His 2004 series on prosecutorial misconduct in Iowa was named a finalist for the Pulitzer Prize for Investigative Reporting. From October 2018 through November 2019, Kauffman was an assistant ombudsman for the Iowa Office of Ombudsman, an agency that investigates citizens’ complaints of wrongdoing within state and local government agencies.