Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, September 5, 1993 TAG: 9309050239
SECTION: VIRGINIA PAGE: B1 EDITION: METRO
SOURCE: CAROLYN CLICK STAFF WRITER
DATELINE: LENGTH: Long
\ State inspectors paint a grim portrait of life inside the Avante at Roanoke nursing home, where the smell of urine permeated rooms, and some elderly patients wore stained, dirty clothing and went several days without baths.
Some call buttons did not work. Bedsores were common. Air conditioners malfunctioned. Flies and other insects were seen near food trays. Feces were found on toilet seats. Staff was not properly trained to handle emergencies.
The deficiencies, detailed in a 34-page report by the Virginia Department of Health's Office of Health Facilities Regulation, employ the spare, bureaucratic language of regulation.
But behind the federal and state citations are poignant observations, revealing snapshots of what life was like on five days in July when state inspectors paid a surprise visit to the 141-bed facility.
Verbatim entries from the report include:
During the 7-20-93 orientation tour and three days of the inspection process a male resident was observed in the corridor wearing pants with the zipper halfway down due to improper fit. Staff interview confirmed "that the pants are too small, but he has no more."
On 7-27-93, a female resident who had long dirty fingernails and was wearing stockings with holes was observed in a chair. A family member, during interview, confirmed that the facility staff has been requested on several occasions to clean up the resident.
A resident observed on 7-22-93 at the breakfast meal was sitting up in bed. This resident had multiple food stains on his clothes. The resident stated "they don't have any of the nice covers (bibs) and today they said they ran out of towels which they use sometimes. I am sure they will get me clean clothes sometime today." A staff interview confirmed that the facility doesn't have enough bibs for all residents requiring them and there is a shortage of towels.
Facility staff were passing ice to the residents from an ice cooler that contained ice and stagnant water. These same coolers were not emptied after the ice was passed.
During the orientation tour, the medication refrigerator on Unit 1 had a sticky bottom and the door shelves had food debris and a sticky substance.
A resident was observed walking in the corridor holding his arm up. There was obvious redness and swelling. The staff was interviewed regarding this ambulatory resident. There was no documentation regarding any incident of injury and the staff was unaware if anybody "had really noticed the resident's arm."
A resident was observed sitting in the corridor with a bleeding left cheek. Staff was in the area. There was no effort to intervene until the inspector asked a staff member to check the resident.
The inspector overheard a resident yelling for help. Staff was observed in the corridor outside the resident's closed door. The inspector returned about 20 minutes later and the resident was still yelling. A staff member was then asked by the inspector to check on this resident. It was determined that the resident was sitting in a chair and could not reach the call bell. The resident was only dressed in a diaper and shirt.
During the inspection process, there were several occasions that a resident on Unit 1, 2 or 3 would have a call light on or need assistance. Some residents on these units were observed to wait seven to 10 minutes for a call bell response. Two residents on Unit 3 had a call bell response time of eight minutes. One of these residents voided in the floor because she was unable to get to the bathroom alone.
During the orientation tour and all the days of the inspection process multiple flies were observed in all the resident care areas.
The report further cited the facility for failing to properly and periodically assess patients for changes in physical and mental condition and for failing to help each resident maintain his or her highest level of function.
There were documented instances of patients refusing medication, but doctors were not informed of the refusals.
Perhaps most damaging to the reputation of the King George Avenue facility was the Health Department's assertion that the home had "failed to report to the Office of Health Facilities Regulation 11 of 12 alleged incidents of resident abuse and injuries of unknown origin."
Two alleged incidents of exploitation also went unreported, according to the statement of deficiencies released last week.
The July 20-23 and 26-27 visit by state inspectors was a follow-up to the annual state licensure and certification inspection conducted in December.
Filed with the report is the facility's plan to correct the federal and state deficiencies. Avante's plan has been accepted by the Office of Health Facilities Regulation, said Connie Kane, director of the Division of Long Term Care Services.
The facility has until Friday to carry out its announced reforms. And while the facility does not have to be 100 percent in compliance with state and federal regulations, "We have to determine that they are making substantial progress," Kane said.
In its defense, facility Administrator Bruce Wood said all 12 alleged incidents of abuse and injuries were disclosed to the local office of the state's nursing home ombudsman program as well as to Adult Protective Services. As part of the facility's plan of correction, Wood agreed to notify the Office of Health Facilities Regulations of all future incidents.
The LOA Area Agency on Aging, a member agency of the Virginia Department for the Aging formerly known as the League of Older Americans, confirmed it investigated 12 complaints at Avante through its ombudsman program this year.
Of the nine allegations of physical abuse, three were verified, one partially verified, two were not justified and three were undetermined because of insufficient evidence, said Laura Pollock, a case manager.
Because of confidentiality issues, she could not detail the nature of the abuse allegations.
There were two allegations of exploitation, which is defined as taking money or personal effects from residents without permission. One was verified and one was found to be undetermined.
A complaint of poorly trained staff was determined not to be justified.
The Office of Health Facilities Regulation will return to the facility by Friday to determine if the facility is in compliance with state and federal regulations.
"The goal is not to close facilities. The goal is to assess," Kane said. "We are not even allowed to have a consultant role. We determine compliance, that's it."
Kane said the process would be speeded up - and the institution placed on a 23-day track to correct deficiencies - only if inspectors believed the well-being of residents to be in serious jeopardy.
"If there was indeed a threat to a resident's health, we would be back in there," Kane said. "We would respond to the most dangerous situations. Once we are in a 90-day track, we usually don't go in without just cause.
"We don't want to close the facility," Kane said. "We don't want to move those patients, unless it's hazardous."
by CNB