Feds question fire safety in Iowa nursing homes, but DM home remains uninspected

By: - August 27, 2021 1:26 pm

A federal report has concluded Iowa is doing a poor job of enforcing fire-safety regulations in nursing homes. (Photo courtesy of Des Moines Fire Department)

The state fire marshal’s office is not planning to inspect a home for seniors in Des Moines until a judge upholds the state’s position that the home is illegally operating as an unlicensed care facility.

The decision comes just seven months after a federal investigation concluded that Iowa is doing an inadequate job of enforcing fire-safety regulations at nursing homes.

Sutton Senior Homes, located in a single-family residential home just off Park Avenue in Des Moines, has been admitting tenants since 2017, with a half-dozen residents paying up to $9,500 per month, state records show.

The Iowa Department of Inspections and Appeals and the City of Des Moines have alleged in court that the home and its owner, Anne Porter of Ankeny, are running an illegal, unlicensed care facility out of the house at 3219 SW 39th St.

They allege DIA inspectors visited the house last fall, reviewed the level of care needed by the six people then living in the house, and concluded it was functioning as either a residential care facility or an assisted living program, both of which require state licensure or certification as well as fire-safety inspections.

However, the state fire marshal’s office said this week that regardless of what the state’s position is, it won’t be inspecting the home until an administrative law judge or court upholds that position.

Special Agent in Charge Kyle Gorsh with the State Fire Marshal’s Office said it’s “up to the Department of Inspections and Appeals” to determine what level of care is provided in the home and whether it meets the legal definition of a residential care facility or an assisted living center.

“They have the professionals who determine what level of care is being provided, and does that level of care require a specific license,” Gorsh said. “We don’t have the expertise to determine that.”

It has been 10 months since DIA determined the home was operating illegally without a care-facility license, and two months since it took the owner to court over the issue. Still, Gorsh said, the owner is disputing DIA’s findings, and so the need for licensing and inspection remains an unanswered question. That question is being litigated, he said, and the process needs to play out.

“Until that is determined, we don’t even know how to go in and inspect the building because there’s different types of requirements,” he said. “That first piece, the licensing, has to be resolved and that’s ongoing between DIA and the owner.”

An administrative hearing in the case is scheduled for late November.

Feds: Iowa failing on fire-safety oversight 

In February, three months after DIA first alleged Sutton Senior Home was illegally operating without state oversight, the Office of Inspector General at the U.S. Department of Health and Human Services issued a report that said Iowa was doing an inadequate job of enforcing federal fire-safety and emergency-preparedness  requirements in nursing facilities.

A bird’s nest blocks a sprinkler head at an Iowa nursing home. (Photo courtesy of Office of Inspector General, U.S. Department of Health and Human Services)

The OIG said it conducted on-site inspections in 2019 at 20 Iowa nursing homes with a history of serious, past violations and identified significant, new violations related to life safety and emergency preparedness at every one of those homes.

“We found 122 instances of noncompliance with life-safety requirements related to building exits, fire detection and suppression systems, hazardous storage, smoking policies, and electrical equipment maintenance, among others,” the OIG reported. “We also found 133 instances of noncompliance with emergency preparedness requirements related to written plans, emergency power, emergency communications, and training, among others.”

None of the nursing homes referenced in the report are identified.

The OIG concluded that residents of the 20 nursing homes “were at increased risk of injury or death during a fire or other emergency” and the office blamed Iowa’s Department of Human Services – the agency that provides Medicaid funding for the homes – for not having “a standardized life safety training program for all staff.”

A nonfunctioning emergency light at an Iowa nursing home is tested by a federal inspector as part of a review of enforcement of fire-safety regulations. (Photo courtesy of Office of Inspector General, U.S. Department of Health and Human Services)

In addition, the state was not adequately following up on violations that had been previously cited, and was not requiring either the nursing homes or the contractors hired to inspect sprinkler systems, fire alarms and other devices to physically tag any systems that were in disrepair but considered critical to the safety of residents.

DHS also wasn’t requiring the homes or their contractors to notify the state of those deficiencies once they were discovered, the OIG reported.

In one instance, a sprinkler system could not even be inspected due to excessive leaking from the fire pump. “This raises a question,” the OIG’s office stated. “If the system could not be inspected, would it work in an emergency?”

Among the OIG inspectors’ other observations:

  • Eighteen of the 20 Iowa homes had one or more violations related to building exits, smoke and fire barriers and smoke partitions.
  • Ten to the 20 homes had one or more deficiencies related to their fire detection and suppression systems. Two of those facilities had sprinkler system heads that were blocked or obstructed, and one facility did not have its sprinkler system routinely tested and maintained.
  • At one Iowa home, the issues were serious enough that residents were declared to be in immediate jeopardy. As a result, a fire watch – which involves the continuous patrol of the building to look for evidence of smoke or fire – was imposed.
  • Four facilities did not inspect all of their portable fire extinguishers on an annual or monthly basis.
  • Thirteen of the 20 homes had one or more deficiencies related to hazardous storage. Of those, five facilities had gasoline cans or other hazardous chemicals that were not stored in approved cabinets for flammable material.
  • Fourteen of the 20 facilities used electrical power strips and extension cords that did not meet basic Underwriters Laboratories requirements, were unsafely connected to appliances, or were daisy-chained to other power strips.
  • One facility did not have a working generator to provide power in the event of a natural disaster or emergency. Nine of the 20 facilities did not have sufficient water on hand for residents in the event of such an emergency.
A locked gate blocks the path of residents along a fire-evacuation path at an Iowa nursing home. (Photo courtesy of Office of Inspector General, U.S. Department of Health and Human Services)

In a written response to the OIG’s findings, the Iowa Department of Human Services agreed that it had failed to ensure compliance with all federal requirements for life safety and emergency preparedness, but said the findings of the OIG did not accurately reflect DHS’ past history of ensuring compliance.

DHS also disagreed with the OIG’s finding that residents of one Iowa home had been placed in immediate jeopardy due to fire-suppression violations.

The state agency also rejected the OIG’s recommendation that it require nursing homes or their hired contractors to notify the state and tag any critical fire-safety devices that are found to be in disrepair. “The recommendation goes beyond the current Life Safety Code and other regulatory requirements and would require a change in those governing regulations,” the department stated.

In its report, the OIG noted that DHS has delegated enforcement of fire-safety requirements to the Iowa Department of Public Safety’s State Fire Marshal. But because DHS is the agency subject to OIG oversight, the report focused on DHS and its duty to ensure compliance.

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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.