Months of ongoing violations prompt $290K fine against nursing home

A northwest Iowa nursing home accused of dozens of regulatory violations is facing more than a quarter of a million dollars in fines from the federal government.

Beginning Jan. 17, the federal government began fining Aspire of Primghar in O’Brien County $10,100 per day for each day the home failed to meet minimum standards. On Feb. 10, the fine dropped to $550 per day, which is where it remains today, with the home still not in compliance. The fine so far totals $289,150.

Just last year, the Primghar home was hit with $147,869 in federal fines, according to the Centers for Medicare and Medicaid Services.

The current fine is tied to 26 violations of federal nursing home regulations related to a wide variety of issues, including abuse and neglect; professional standards; overall quality of care; treatment of pressure sores; frequency of physician visits; the use of unnecessary psychotropic drugs; medication errors; laboratory services; sanitary food service; staff qualifications; infection control; staff immunizations; and nursing services.

According to state records, one resident of the home was injured when her wheelchair rolled off the ramp on a vehicle that had transported her to an appointment. The resident reportedly rolled backward, then fell three to four feet to the ground and struck a building with her head. She was rendered unconscious, seated upside down while still fastened in the wheelchair that lay on top of her.

The accident resulted in three trips to the emergency room for rib fractures, severe back pain, muscle spasms, and multiple bruises over the woman’s arms, hands, torso, legs and face.

Inspectors also cited the home for failing to have a physician come to the facility for resident assessments and examinations. Although the home’s policy was to have each resident seen by his or her attending physician at least once every 30 days after admission, the director of nursing acknowledged that all of the 28 residents were served by the same physician who was not conducting in-person visits and was instead providing services via telehealth. The home’s business office manager reported she knew of only one instance, in 2019, when the telehealth physician was actually in the building, inspectors reported.

An advanced registered nurse practitioner allegedly told inspectors that a three-day delay in one resident receiving a prescribed antibiotic was likely responsible for the resident’s subsequent hospitalization.

According to inspectors, another resident of the home received a chest X-ray eight days after it was ordered, with the director of nursing explaining that the home “did not have a vehicle to transport residents to the hospital for labs or X-rays.”

Another resident was to be evaluated in mid-December for speech therapy, but that didn’t happen until late February, inspectors said.

The home was also cited for failing to implement infection control procedures to mitigate spread of COVID-19 during an outbreak at the home. Residents with COVID-19 were not quarantined, the staff didn’t wear personal protective equipment as instructed, and disinfection supplies – such as alcohol-based hand sanitizer – were not readily available to the staff, inspectors alleged.

While inspectors watched, a nurse aide left the room of a quarantined resident without wearing a gown. A review of the quarantine rooms showed no receptacles for disposing of PPE, suggesting the PPE was being worn or carried by the staff as they left each room.

With the inspectors still on-site, one resident was hospitalized with COVID-19 and diagnosed with acute kidney injury related to COVID-19, then was transferred from the local hospital to a hospital that could provide a higher level of care. The director of nursing allegedly told inspectors she had recently become aware that the home’s infection preventionist had told employees they didn’t need to wear PPE when entering the rooms of quarantined residents.

The administrator of the home, Chris Rickard, declined to comment on the matter Thursday, but said he was unaware of the $289,150 fine.

While the fine is one of the largest to be imposed against an Iowa care facility in recent years, it is topped by the penalty levied last year against the QHC Fort Dodge Villa in Webster County. After being cited for 18 federal regulatory violations and four state violations, the QHC home was assessed a federal fine for each day it remained out of compliance with minimum standards. The daily fine eventually topped $695,000. It has yet to be paid, according to state records.

Last year, Aspire of Primghar was deemed eligible for inclusion on the federal government’s Special-Focus Facility List, which is a national list of nursing homes considered to have a history of serious quality issues. Another Iowa facility owned by the Aspire company, Aspire of Muscatine, was also deemed eligible for the list.

Aspire of Primghar now has a one-star ranking – the lowest possible rating – from the Centers for Medicare and Medicaid Services, with regard to overall quality of care, health inspections and quality measures.

According to CMS, the home is owned by Bruce Wertheim and Black Hawk Healthcare, a for-profit limited liability corporation.