Death-related violations cited at care facilities in Coralville, Sioux City, Pleasantville

State regulators have cited care facilities in Coralville, Sioux City and Pleasantville for regulatory violations related to resident deaths.

State records indicate that over the course of two inspections in April and May, the Countryside Health Care Center in Sioux City was cited for 30 regulatory violations by the Iowa Department of Inspections and Appeals and fined a total of $74,000 — although all of the fines are being held in suspension while federal officials determine whether to impose penalties of their own.

State records show that at the time of the first inspection in April, DIA had compiled a backlog of 19 complaints to investigate at Countryside. Seventeen of those complaints were substantiated by the state during the inspection.

In April, the Iowa Capital Dispatch reported that Iowa nursing home residents had died or been sexually abused in care facilities while complaints against the homes awaited investigation by the state. In March, for example, state inspectors visited a West Des Moines care facility with a backlog of 23 complaints — the oldest of which had been filed in September of last year. A female resident of that home had been left screaming in pain after contracting gangrene of the genitals and died on March 6 of this year — more than five months after the state fielded the first of the uninvestigated complaints against the home.

As part of its April inspection at Countryside, state officials cited the home for 25 violations. The state alleged the staff at Countryside had failed to intervene after a resident exhibited signs of infection in her legs with heavy, foul-smelling drainage emanating from both limbs. The woman also displayed symptoms of hallucinations and sepsis, a potentially life-threatening infection, according to inspectors. The woman was eventually hospitalized and died several days later. Inspectors reported the woman’s occupational therapist felt the staff had provided “sketchy” wound care.

The home was also cited for a Jan. 25 incident that involved a female resident who was found unresponsive on the floor of her room. The woman was sent by ambulance to a hospital and died en route. Countryside was cited for failing to provide the woman with adequate supervision and for failing to report the incident to the state. The inspectors’ report indicates the home’s director of nursing told inspectors a “corporate nurse consultant” had advised her to refrain from reporting the matter to the state because the woman didn’t die as a result of the fall.

In May, inspectors returned to Countryside in response to three additional complaints, all of which were substantiated. The home was cited for five additional violations.

According to the inspectors’ reports, a resident of the home had been found slumped over in her wheelchair, unresponsive and cold to the touch, on the afternoon of May 2. The woman was treated at a local hospital for acute kidney injury and low urine output and died a few days later. The home was cited for failing to contact the woman’s physician after her urine output slowed and for failing to adequately assess her condition.

Similar concerns were noted with regard to a female resident who had been found in late April sitting in a recliner, slumped over and unresponsive. She was taken to a hospital and diagnosed with acute respiratory distress and sepsis. She died two days later.

Problems at other care facilities

DIA recently fined several other homes for resident deaths or injuries, including Windmill Manor of Coralville, which was fined $325 for failing to report to the state two major resident injuries, one of which resulted in death. On April 14, a resident of the home fell from a wheelchair face first onto a concrete parking lot. The resident was then hospitalized with multiple spinal fractures, an unstable lumbar spine, and bruises to the head and face, according to inspectors’ reports.

After surgery, the resident was hospitalized for a week and then discharged on April 21 with a cervical collar and a back brace. The resident died the next day, on April 22 — eight days after the fall, according to the state.

On May 6, another resident of the home was found lying on a hallway floor, screaming in pain from an apparent hip fracture. According to the inspectors’ report, the facility’s administrator told state officials she was unaware of the fall or the resident’s subsequent hospitalization and surgery until May 9, three days after the fall.

DIA initially fined the home $500, but the penalty was reduced by 35 percent to $325 after the home agreed not to appeal the fine, according to state records.

A third Iowa care facility, Accura Healthcare of Pleasantville, was recently cited for failing to follow prescribed safety interventions for a resident who was known to be at risk of falling. The resident “suffered a traumatic fall” at the home on May 1, inspectors allege, which led to the resident’s subsequent hospitalization and death. When inspectors visited the facility in late May, they investigated the death and a backlog of five complaints against the facility.

The inspectors’ report of their findings indicates that on the afternoon of May 1, a male resident of the home was in his room and was heard calling out for help. The man was found on the floor with five head lacerations and blood pooling underneath his face. He was sent to a hospital emergency room for evaluation, was diagnosed with bleeding in the brain, and he died four day later. DIA has imposed a $10,000 state fine against the home.

According to state inspectors, another resident at Accura Healthcare of Pleasantville fell in January and required surgery to repair a broken leg. The facility failed to report the injury to the state as required and the administrator later stated the home did not have a policy related to the reporting of major injuries.

A fourth Iowa care facility, the Oskaloosa Care Center, was recently sanctioned for injuries sustained by a resident. The state imposed, and then suspended, an $8,750 fine against the Oskaloosa home for failing to provide residents with the required nursing services. Inspectors allege the staff failed to intervene in a timely fashion when a male resident was unable to urinate for three days. The resident was rushed to a hospital by ambulance after he was observed in bed with his eyes closed, fists and teeth clenched, with a distended abdomen, swollen legs and fluid oozing from his extremities.

At the hospital, doctors reported that after they inserted a catheter the man discharged three full liters of thick, bloody drainage “similar in appearance to a strawberry smoothie.” The man was diagnosed with an acute kidney injury and sepsis, a potentially life-threatening infection. The inspectors’ report gives no indication as to whether the man survived.

This article first appeared in the Iowa Capital Dispatch.