Care Initiatives facilities found in violation

Creston Specialty Care was included in a series of violations in which several Iowa nursing home facilities were cited. The Health Facilities Division of Iowa Department of Inspections and Appeals investigated the original complaints, many of which were substantiated.

All six of the nursing home facilities cited are owned and operated by Care Initiatives, a West Des Moines corporation.

In all, allegations against the Iowa nursing homes included multiple complaints of abuse, neglect and medication errors. Fines of more than $80,000 have already been assessed against these facilities and more may follow.

Southwest Iowa’s Health Facilities Compliance Officer Jolyn Meehan visited the facility in September to investigate alleged violations.

Meehan determined sometime between 3:45 a.m. and 4:15 a.m. on Aug. 16 at Creston Specialty Care, a female resident wandered away from the building. The door alarms had sounded as designed, but the employees did not respond and were unaware the resident had left the building until Greater Regional Health called to report the woman was in their emergency room.

The resident did not have a wanderguard bracelet on, but had been exit-seeking earlier in the shift. The investigation report stated staff failed to implement interventions to ensure the resident’s safety.

The former Director of Nursing told Meehan the resident did not want to lay down that evening or on night shift. The night nurse said residents had repeatedly gone to the door and opened it to look outside, setting off the alarms. The nurse said he provided one-on-one care with the resident in question until he needed to provide care for another resident.

The woman was spotted by a hospital employee at the bottom of a steep hill near dumpsters about 200 ft from the building. After reviewing camera footage, it was determined the resident had been outside the building for approximately 30 minutes. The temperature outside was reportedly 63 degrees with 100% humidity and light rain.

Multiple interviewed staff members reported one member dismissed concerns about the alarms, saying “everything is OK.” They reportedly saw her silence the alarm more than once without checking the doors.

The report stated, “This situation presented an immediate jeopardy to resident health and safety.”

An $8,000 state fine was imposed for the violation of 58.28(3)e which states, “Each resident shall receive adequate supervision to protect against hazards from self, others or elements in the environment.” The facility also received $20,610 in federal fines, for violation of Code F689 - Free of Accident Hazards/Supervision/Devices.

Provacative Medical Review says F689 was the third most cited in 2021. The intent of F689 is to ensure the facility provides an environment free from accident hazards over which the facility has control, and provides supervision and assistive devices to each resident to prevent avoidable accidents.

There are several types of accident hazards included with this regulation including: smoking, assistive devices, resident-to-resident altercations, vulnerability, environmental hazards, falls, electrical safety or elopement (when a resident leaves the facility without staff knowledge or permission.)

They were also cited for an incident on April 18 when sometime after supper, a staff member transferred a resident by herself using a mechanical lift. While the resident remained upright in the lift, the staff member stepped away from the resident to obtain a supply item. The lift then tipped over and the resident fell to the floor. An x-ray completed on April 20 showed the resident sustained a fractured humerus.

The citation report states, “The facility failed to implement interventions and provide adequate supervision and proper use of assistive devices to mitigate a resident’s risk for elopement and an accident for two of five residents reviewed.”

Clark Kauffman with Iowa Capital Dispatch collected the following information.

There were multiple complaints of major violations alleged against the six Care Initiatives nursing facilities in Iowa. These complaints were among those substantiated by state inspectors:

• Stratford Specialty Care – A resident wandered out of this facility and off of the property. The door alarms sounded, but employees did not respond. The noise from the alarms led two kitchen workers to notify the nursing staff. However, the employees still took no action. The resident was found wandering along a state highway by one of the kitchen workers.
• Cedar Falls – Pinnacle Specialty Care – There were seven complaints against this facility, including one for the fentanyl overdose of a female resident. The overdose happened because the nurse administering the drug failed to remove an older medication patch. This resulted in both the older patch and the newly-placed patch delivering fentanyl into the woman’s system.
• Ottumwa – Ridgewood Specialty Care – A physical therapist reported a resident’s swollen and purple foot to a nurse. However, the facility took no action and provided no treatment for the resident’s foot. Just six days later, the resident was transported to a hospital emergency room. A vascular surgeon diagnosed the resident with gangrene. By that time, the damage was irreversible. The surgeon recommended amputating the foot. The family declined surgery and instead placed the resident in hospice. Ridgewood was fined $8,000.
• Ottumwa – Ridgewood Specialty Care – Cited and fined for verbal abuse of a resident suffering from traumatic brain dysfunction. An aide yelled at the resident for moaning and crying, saying, “Just shut up. Shut the f__ up.” A $500 fine was imposed for resident abuse.
• Sioux City – Westwood Specialty Care – A female resident at this facility fell and suffered multiple fractures. Her injuries included several broken ribs, a broken wrist, fractured pelvis and a fractured collar bone. According to inspectors, this facility failed to take proper action for a resident who was a known fall risk. A $30,000 state fine was held in suspension with the matter referred to federal officials for further action.
• Waterloo – Ravenwood Specialty Care – This facility received 19 complaints. State inspectors substantiated 18 of them. Ottumwa Post reports that one entire dementia wing at the facility was left completely unstaffed. The facility received a $10,000 state fine.

Care Initiatives did not respond to a request for comment from Kauffman. The company operates 43 care facilities that are home to as many as 2,800 older Iowans. It is the largest nursing home chain in Iowa and is organized as a tax-exempt, nonprofit corporation.

Care Initiatives facilities generated $213 million in revenue in 2020 and reportedly spent $207 million. The federal government provided additional emergency grant relief money due to the COVID-19 pandemic. Care Initiatives also reportedly collected $7.9 million in federally-issued grant relief funds.