Nursing home has record of investigations: Ruxton Health of Williamsburg has had 28 complaints since January 2006.

By Danielle Zielinski

WILLIAMSBURG, Apr. 23, 2008 (McClatchy-Tribune Regional News delivered by Newstex) --
In the Virginia Department of Health's complaint investigation records, the woman is referred to only as Resident No. 8.

She was admitted to Ruxton Health of Williamsburg in September 2005. She was about 5 feet tall, weighed 129 pounds, and primarily spoke Spanish. She was diagnosed with diabetes, hypertension, osteoporosis and cataracts.

The complaint states that a family member visited the resident at the nursing home almost daily, noticed changes in her starting around Oct. 4, 2006, and told staff. On Oct. 13, he "found her to be extremely ill looking, shaking, had breathing problems, purple feet, mouth was black with sores, reddened face, screaming for help, holding her stomach and soaked with urine."

Although staff said the resident was not in imminent danger, her family insisted she be taken to the emergency room. She was admitted to the intensive care unit and died two days later.

"He was told in the hospital the resident expired from complications of dehydration and had a blood sugar of 555 upon arrival to the ER," the investigation report states. Normal blood sugar levels are in the range of 70 to around 100 milligrams per deciliter of blood.

Resident No. 8's case is just one of 28 complaints lodged against Ruxton since January 2006, according to the Department of Health's Office of Licensure and Certification. Those complaints included a total of 73 allegations -- 22 in which the facility was cited for deficiencies, nine in which the allegation was substantiated but no deficiency was found, and 42 that were determined to be unsubstantiated.

Ruxton is also being investigated by the Williamsburg Police Department regarding possible elder abuse, after 84-year-old Lorina Wiggins was taken from the home to a local hospital in March with multiple, infected sores on her body. Wiggins later died. The medical examiner's office has not yet made a determination as to the cause of her death.

Bob Fagan, administrator for Ruxton Health of Williamsburg, said Tuesday that no one at the facility would address specific complaints.

"We continually strive to give the best care possible to all of our residents, and we will continue to do that going forward," he said.

The investigative reports from the 22 allegations where deficiencies were cited paint an ugly picture of life at Ruxton. The findings included staff members neglecting to feed a patient regularly, dirty rooms and flies on residents, residents lying in their own urine, staff members not giving medications on time, and the facility not taking the proper precautions to avoid pressure sores on residents.

In the case of Resident No. 8, the state health department cited Ruxton for three deficiencies: improper hydration, poor quality of care, and failing to notify the appropriate people about a change in Resident No. 8's status.

In interviews with nurses and other staff at Ruxton, the investigator determined that the resident's blood sugar levels were consistently high in the days before her admittance to the hospital, and "the facility staff failed to address and treat Resident #8's elevations in blood sugar."

In another case, a patient who was supposed to be fed every three hours through a tube was admitted to a hospital Feb. 19, 2007 -- clinically dehydrated with elevated levels of sodium in his blood. Nurses' records were so incomplete that investigators said it was possible the man missed as many as 75 feedings from December 2006 to February 2007, according to the state records.

"This shows a pattern of feedings that were most likely omitted," the investigator states in the report. "This would decrease the level of fluids the resident may have received and could have resulted in his dehydration."

The man was discharged from Ruxton to a hospice home and died shortly thereafter, the report states.

Other findings include the facility serving cold food, staff members failing to notify the proper authorities about a possible sexual assault, and staff members failing to notice when a resident left the facility and wandered away.

Less-serious findings included stained carpets and sheets, strong odors in the facility, and staff members not wearing identification badges.

Chris Durrer, director of licensure and certification for the Department of Health, said that whenever deficiencies are found -- through a complaint or an inspection -- a facility is usually given a period of time to correct them. Investigators then revisit the facility up to three times within a 180-day time frame to see if the problems have been addressed.

"If they're not corrected at the 180, then they would lose their (Medicare and Medicaid) funding," Durrer said.

Failure to correct deficiencies in a timely manner can also result in fines, he said.

The complaint investigation records from Ruxton do not say what actions were taken to address the deficiencies found, or whether the facility complied within the 180-day time frame.

All nursing home facilities in the state undergo inspections for licensure every two years, and annual certification surveys for federal reimbursement under Medicare and Medicaid. Ruxton Health of Williamsburg has been licensed under its current owner, Columbia, Md.-based Ruxton Health Care, since April 2004, Durrer said.

An October 2006 inspection done at Ruxton for Medicare/Medicaid certification revealed 26 health deficiencies, including problems with the treatment of bedsores and problems ensuring residents received help with eating, drinking, grooming and hygiene, according to a database compiled by the Center for Medicare and Medicaid Services. The number of deficiencies at Ruxton was more than triple the state and national average of eight deficiencies.

All but six of the deficiencies were corrected by December 2006, according to the database.

A January 2008 inspection revealed 13 deficiencies, including problems controlling the spread of infection at the facility and failures to investigate injuries to residents, according to records provided by the Department of Health. All deficiencies were corrected by a second visit on March 6, the records state.

Where to see inspection results
The Center for Medicare and Medicaid Services maintains a database with information on all nursing homes nationwide that accept federal reimbursement for Medicare and Medicaid patients.

--To see health and fire inspection results and quality care statistics for nursing homes near you, go to www.medicare.gov, and click on the "Compare Nursing Homes in Your Area" link listed under "Search Tools."

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