For more than two years, the Iowa Department of Inspections and Appeals has failed to meet federal standards for the timely inspection of nursing homes.
The federal Centers for Medicare and Medicaid Services requires each state’s nursing home inspection agency to conduct a full inspection of every licensed care facility no later than every 15.9 months. It also requires those inspections to occur, on average, within 12.9 months.
The Iowa Department of Inspections and Appeals has failed to meet the latter standard every month since October 2017. During 2019, the average time between inspections sometimes exceeded 15 months.
According to the inspections department, the average interval between inspections dropped to 13.3 months in December — a marked improvement, but one that wasn’t enough to bring the state into compliance. Nationally, the average interval between inspections was as low as 12.5 months in 2019.
According to the Iowa Auditor of State, DIA officials have said they are evaluating the need to increase the number of full-time employees on staff to meet the federal requirements.
DIA spokeswoman Stefanie Bond said the bureaus responsible for inspecting nursing homes are close to being fully staffed now, and interviews are being conducted to fill the two positions that remain vacant. The department will have 48 full-time nursing home inspectors once it is fully staffed, she said.
DIA continues to make use of temporary inspectors, all of whom are retired Iowa nursing home inspectors, Bond said. Last summer, the department also utilized federal contract inspectors to complete seven care-facility inspections.
DIA is responsible for the inspection of 438 nursing facilities in Iowa. During the fiscal year that ended June 30, 2019, there were 346 such inspections.
In recent months, the agency cited several Iowa homes for serious, alleged violations:
- The Fleur Heights Care Center in Des Moines was cited in November for failing to immediately respond to and report the suspected abuse of three dementia patients by one of its long-time caregivers. The worker allegedly twisted and pulled off one resident’s briefs with enough force to tear the garment; told another resident to “shut up;” and placed her hand over a third resident’s mouth to stifle the woman’s screams. Another caregiver told inspectors the worker handled one of the residents “like a piece of meat.” No fines or penalties were imposed by the state.
- Holy Spirit Retirement Home in Sioux City was cited in October for a failure to properly move a resident, which resulted in the resident falling and breaking a leg. The resident was taken to a hospital, diagnosed with sepsis, and died a short time later. A federal fine of $8,294 was imposed.
- The Good Samaritan home in Indianola was cited in January for mistakenly administering the wrong medication to a resident, who then had to be hospitalized. The home was also cited for failing to tell the state about a resident’s complaint that a caregiver had taken and used his debit card. The caregiver told her supervisors she mistakenly put the card in her billfold and took it with her on vacation. The state imposed a $6,000 fine against the home, but suspended it pending federal action.
- Atlantic Specialty Care was cited in January for failing to have a resident’s prescribed pain killers on hand in the days following the resident’s abdominal surgery. According to the state, the resident suffered from “excruciating” pain for two days due to the home not having pain killers available. The state imposed a $7,250 fine against the home, but suspended the penalty pending federal action.
- Crestview Acres of Marion was written up in December for 107 pages of deficiencies related to unsanitary conditions and unsafe food handling; a pest-control problem that included cockroaches in the kitchen; poor housekeeping and building maintenance; failure to provide call-lights for all residents; failure to investigate allegations of physical abuse; failure to meet minimum standards for wound care; failure to adequately train workers in the dementia unit; a medication error-rate of more than 5 percent; failure to employ a dietitian; and failure to serve food at a safe and palatable temperature. The state imposed a fine of $13,500 but suspended that penalty pending federal action. Some of the same violations were found last spring when the federal government imposed a fine of $59,927 against the home.