Midtown care home is denied Medicare funding

By Rhonda Bodfield

Jun. 8, 2008 (McClatchy-Tribune Regional News delivered by Newstex)

-- The federal government won't pay to send new patients to a Midtown nursing home after inspectors said in April that it didn't properly care for patients or do enough to protect residents from sexual abuse.

The Centers for Medicare and Medicaid agreed with state health inspectors that a "substandard quality of care" was being provided at Santa Rosa Care Center, 1650 N. Santa Rosa Ave., at the time of its last annual inspection.

It suspended Medicare payments for new admissions until Santa Rosa proves it is in substantial compliance.

The federal government also slapped the care center with $7,000 in fines.

As a result of the federal decision, Pima County's non-profit health system, which is responsible for placing the low-income elderly in long-term care centers, has stopped sending new patients to Santa Rosa.

Sylvia Balistreri, who heads the state licensing arm for long-term care, said the May 27 decision was based on the fact that the center was found to be putting patients in "immediate jeopardy." That's the worst possible rating a nursing home can get, stemming from conditions so severe that inspectors will not leave a facility until the problem is addressed.

In this case, Santa Rosa had to promise to provide one-on-one supervision to a resident with a history of sexually inappropriate behavior, to prevent further sexual contact with other residents.

The corrective-action plan also required a medical and psychiatric assessment of the resident, as well as more training for the staff in dealing with "sexually expressive" residents.

"It's just an example that demonstrates our commitment to protecting the health and safety of residents," Balistreri said. "Our recent patterns of surveying and citing are evidence of that, and this is just another example."

The public wouldn't know that there were problems with the facility, however. The most recent posting on the state's enforcement Web site shows the last survey took place in December and inspectors found no violations. The new findings also aren't in the public file.

Balistreri said the April survey hasn't been posted in the public file because the nursing home has 60 days to appeal the findings.

Santa Rosa administrator Kim Arndt did not return calls seeking comment.

JoAnn Siemsen, a spokeswoman for the county's Pima Health Systems, said the agency still has 85 elderly clients placed at Santa Rosa but is reviewing the situation.

"Each one of those people has a case manager, and we are actively involved in making sure they get quality care," Siemsen said.

Inspection records show that a survey team discovered in April that the facility had failed to report the alleged sexual abuse of at least two residents. "The facility wasn't acting in the best interest of those patients or working on their behalf to safeguard them," Balistreri said.

The perpetrator in the case had been transferred from another facility in November because of inappropriate sexual behavior. By December, Santa Rosa staffers had documented at least one episode of such behavior, but did not report it to the state and did not put details in the man's records.

In January, after other incidents were documented, including an attempt to pull down another resident's pants, Santa Rosa ordered staffers to do 15-minute checks on the patient because his inappropriate behavior appeared to be increasing. There was no consistent and routine documentation that the monitoring plan was followed.

The man reportedly had sexual encounters with two residents, including a March incident with another resident diagnosed with dementia and Alzheimer's disease.

The administrative staff indicated that no investigation was done because the contact was considered consensual, since there were no apparent signs of resistance. The nurse who separated the two, however, said when she did, the Alzheimer's patient thanked her.

The staff could not provide a definition of consent from an incompetent resident and did not take any specific action to prevent further sexual abuse of the man's peers.

An administrative staff member, in an interview with state surveyors, reportedly responded, "If this were a typical nursing home, would you document if a little old lady and a little old man were having sex?"

Santa Rosa also was written up for not caring appropriately for other residents.

One woman fell in the bathroom and was given Tylenol for ankle pain. It wasn't until almost a full week later that the care center determined she had fractured her ankle, even though the woman said she told staffers that her pain was at least an 8 on a 10-point scale even with the Tylenol.

In another case, a man fell during a seizure and was unconscious for 10 minutes. According to inspection records, Santa Rosa did not tell the man's doctor that as the days progressed, he became increasingly confused, was very weak and needed assistance to walk and eat. When the man was sent to the hospital 10 days later, doctors determined he had intracranial bleeding from the fall.

The center was also written up for failing to report other injuries, including a few falls with broken bones or lacerations, to the state as required, and for failing to take appropriate interventions that might have helped one resident maintain bowel and bladder function.

--Contact reporter Rhonda Bodfield at 573-4118 or at rbodfield@azstarnet.com.

Newstex ID: KRTB-0014-25837224