State: Nursing home staff abused residents through intimidation, punishment

A southern Iowa nursing home has been cited by the state for abusing two of its residents through unreasonable intimidation and punishment.

It’s the second time in seven months the Lenox Care Center in Taylor County has been cited for resident abuse. Last year, a nurse at the home allegedly tied a resident of the home to a chair using a bed sheet.

The latest allegations involve two residents of the home who were reportedly denied food, beverages or privileges because the staff felt their incontinence was deliberate, attention-seeking behavior.

According to state inspectors’ reports, facility records show that last spring and summer, one female resident of the home was repeatedly denied the opportunity to go outside or smoke when she declined to take a shower or refused a meal.

Last June, the home’s director of nursing wrote in the resident’s file: “(She) refused a bath yesterday and has refused to come out to meals today. Informed her she will not be smoking all weekend due to her choices.”

The next day, the director of nursing wrote: “(She) refused to get out of bed for lunch or breakfast. She laid in her bed and wet it until all blankets were soaked. She has been told she is not going out to smoke all weekend due to her refusing her bath and there is nothing she can do until Monday until she can get a bath. (She) signed a contract she would take a bath or she could not go out to smoke.”

In February, a nurse wrote in the file that the woman was “was very rude” to the staff and was “yelling and screaming at them because they won’t push her wheelchair to the dining room. Staff explained that it was part of her therapy and she needed to do it herself.”

In March, the nurse wrote that the woman was in the dining room and repeatedly asking for a second helpings of food, which the staff refused to provide. The staff reportedly showed the woman a contract in which she had apparently agreed with the staff dietician to refrain from asking for second helpings.

After the woman made a fifth request for second helpings, the charge nurse informed that “with this type of behavior there could be consequences” and told the resident she wouldn’t be let outside to smoke.

State inspectors later reported they reviewed the “contract” referenced by the staff and noted that it was not signed by the resident, the staff dietician or any employee of the facility.

Inside the resident’s room, the inspector found a sign posted to the wall that said, “You agreed with the dietitian that you will not ask for extra food at meal times and extra snacks as you have had substantial weight gain.” It was signed by the home’s director of nursing.

Another female resident of the home had allegedly been told there was no reason for her to summon the staff to her room every two hours for bathroom assistance. A nurse’s notes in the resident’s file stated: “(She) was incontinent of urine at 4 p.m., 6 p.m., and 10:45 p.m., and incontinent of bowel at 8 p.m. (She was) educated that there was no reason for her to be incontinent at all as she was the youngest resident here and has had no children … (She) only has accidents for attention and when she was mad and she doesn’t get her way on something…”

Another note in the resident’s file stated: “(She) was very rude and snarky with CNAs, she was incontinent for no apparent reason. Resident #6 had always done this for attention even before she came to this facility … (She) mumbles under her breath, being mean and nasty to staff then lying about her cares when staff have been in her room two at a time due to her behaviors and lying. The writer of this progress note stood outside her room and listened and intervened to her pouting.”

Other notes in the resident’s file stated, “She was increasingly incontinent for no reason other than for attention and/or she was mad … (She) continued to manipulate staff and (be) incontinent for attention… (she) was incontinent of bowel two times yesterday. Not allowed to have coffee today.”

According to the state inspectors’ reports, the director of nursing was suspended on March 31 “for alleged abuse pending the investigation.”

The Iowa Department of Inspections and Appeals imposed, and immediately suspended, several fines against the facility totaling $27,000. The fines tied to findings of resident abuse in the form of unreasonable intimidation and punishment; failing to put in place interventions to prevent falls; failing to ensure staff members possessed the basic skills necessary to address residents’ needs; and failing to report to the state resident abuse and accidents with major injuries.

The state fines are being held in suspension so that federal officials can consider imposing a fine against the facility. According to state records, the home is managed by Arboreta Healthcare of Florida.  The company is headed by CEO Louis Collier and operates 21 health care facilities in Iowa and a total of 10 facilities in Nebraska, Texas, Florida and Georgia.

Federal officials fined Lenox Care Center $34,661 last year for the alleged physical abuse of a resident.

According to state records, a female resident of the home was trying to leave the facility the evening of Aug. 20, 2022, when a nurse approached the doorway and grabbed her by the arm to force her back into a common area used by residents.

As she was pulled backward, the woman allegedly began to scream and cry out, saying, “Ow, stop, you are hurting me … You are abusing me, I know my rights.”

According to workers at the home, the woman fell to the floor and the nurse grabbed her by the shoulders and forcibly “slammed” her into a chair, and then instructed an aide to hold the woman down while the nurse wrapped a sheet around the woman’s legs to tie her into the chair.

According to the workers’ description of the incident, the woman “was fighting like hell to get out of the chair” and was screaming, “Help! Why are you doing this?” When the accused nurse was interviewed by inspectors, she denied having abused the woman.

Asked why she had asked a colleague to bring her a bed sheet, the nurse admitted making the request but said she quickly decided she “just could not do it” and so she never used the sheet — a claim that was contradicted by other staffers.