State inspection finds problems at Royal Oaks

Inspection turns up 13 violations; home says it’s working on correction

By Sue Loughlin

TERRE HAUTE — A January inspection of Royal Oaks Health Care and Rehabilitation Center confirmed 13 violations of federal regulations, but no residents were harmed by those deficient practices, according to a spokeswoman for a federal agency with nursing home oversight.

The Indiana Department of Health conducted an investigation in response to complaints by an individual concerned about the quality of care being provided to a relative at Royal Oaks, a long-term, skilled nursing facility on Maple Avenue in Terre Haute.

“There were deficient practices and violations of federal regulations, but no one was actually harmed,” said Ellen Greif, a spokeswoman with the Centers for Medicare/Medicaid Services Chicago regional office. “There is corrective action that needs to occur.”

States license nursing homes, which must meet certain requirements before they can participate in Medicare/Medicaid programs.

The individual who made the complaints to the state said “there has been insufficient staff-to-resident ratio and not enough staff to ensure residents’ safety” at Royal Oaks. She asked to remain unnamed.

Her relative was taken to Union Hospital in January because of serious bedsores that became infected. The relative also contracted sepsis, a condition in which the body is fighting a severe infection that has spread via the bloodstream.

The woman said the relative did not have bedsores when she entered the facility last fall.

When contacted about the state survey and cited deficiencies, Royal Oaks administrator Brenda Hatfield provided a written statement. Royal Oaks has submitted a plan of correction and is “confident the state will find us to be in substantial compliance upon their revisit,” the statement read.

The initial Indiana Department of Health inspection occurred Jan. 27 and a followup inspection occurred March 20.

The Tribune-Star obtained a copy of the 90-page survey, which cited such deficiencies as failing to give residents proper treatment to prevent new bedsores (pressure sores) or heal existing ones; failing to have a program to keep infection from spreading; and failing to make sure that nurse’s aides show they have the skills to be able to care for residents.

Eleven out of 18 certified nurse assistants [CNAs] observed providing care failed to demonstrate competent skills in handwashing, use of mechanical lifts and handling of Foley catheters and urinary drainage tubing, according to the report.

Also, in a deficiency related to infection control, the report stated: “The facility failed to ensure a sanitary environment in that seven of 17 CNAs observed providing care failed to remove gloves and/or wash hands once contaminated,” the report said.

The Indiana Department of Health-Division of Long Term Care has investigated the complaints, said Ken Severson, IDOH spokesman. He said he could not comment and that results cannot be made public at this time because another followup survey will be conducted.

Until that process is completed, “We cannot release details,” Severson said.

The Royal Oaks statement indicated “this is normal survey activity and we embrace the opportunity to work with the state to examine and enhance our care delivery system through education and training of staff.

“We have submitted a plan of correction for the issues the state identified and are confident the state will find us to be in substantial compliance upon their revisit. Due to medical records confidentiality laws, we are not at liberty to address specific care situations.”

Another written statement provided by Hatfield states, “Resident care and safety is our number one concern. We take seriously any issues brought to our attention by the state.”

No harm was done to any residents as a result of the 13 deficiencies, although there is the “potential for more than minimal harm that is not immediate jeopardy,” according to a rating of the scope and severity of the deficiencies.

Some of the deficiencies were isolated, while others showed a pattern. None was widespread, Greif said.

Putting the matter in perspective, she said there are several hundred regulations that must be met, and Royal Oaks was deficient in 13. “Very few nursing homes get through with zero deficiencies,” said Greif, who is manager of the long-term care certification and enforcement branch.

Other areas where the nursing home failed to meet federal standards include:

• Having enough nurses to care for every resident in a way that maximizes the resident’s well-being.

• Making sure that each resident who enters the nursing home without a catheter is not given a catheter unless it is necessary.

• Making sure that residents who cannot care for themselves receive help with eating/drinking, grooming and hygiene.

• Making sure the doctors visit residents regularly, as required.

• Having drugs and other similar products available, which are needed every day and in emergencies, and give them out properly.

A “five-star” nursing home rating system by the Centers for Medicare and Medicaid Services lists Royal Oaks as having the lowest possible overall rating of one star, which means “much below average.” The rating system is based on health inspections, nursing home staffing and quality measures.

The nursing home responded to the Five Star Rating system with a separate statement: “We support collecting and publicly disclosing valid and timely quality information that provides the public with accurate data on which to select and evaluate nursing facilities. While the Five-Star Rating System is a useful tool for comparing nursing homes, in evaluating nursing centers there is no substitute for visits to nursing facilities and face-to-face discussions with caregivers as well as observing caregivers interacting with residents.

“One of the best measures of quality is customer satisfaction. At Royal Oaks Health Care and Rehabilitation Center, 79 percent of our residents and families rated our nursing home as ‘excellent’ or ‘good’ and 80 percent would recommend our facility to others.”



Sue Loughlin can be reached at (812) 231-4235 or sue.loughlin@tribstar.com.

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