At last night's NorCo Council meeting, an uncharacteristically somber Exec Tara Zrinski informed the Board that Gracedale's nursing home license has been downgraded from Provisional II to Provisional III as a result of deficiencies at the home on September 10 and 24. But she also indicated that she finally gets it and will seek a management consultant to help turn things around. She added that she has also shared a draft of her strategic plan for Gracedale with Council member Dave Holland. She has asked him to keep it to himself.
According to Zrinski, a nursing home with a Provisional III license can be fined at different rates. Centers for Medicare and Medicaid Services (CMS) has fined the county $16,350 for the September 10 deficiency. This is in addition to $144,328 in fines assessed since Michelle Morton has been running the facility.
Morton is resigning as Administrator, and Zrinski now concedes that "some of [her] reactions to the surveyors may have not been in our best interests. Zrinski is alluding to a previous attitude of defensiveness. "That's not what surveyors want to her," she acknowledged. They want to hear that we identify the issue, will not dismiss it and that we will ensure that it does not happen again in the future. She conceded that past practice has been to appeal deficiencies, "to no avail."
Zrinski also prepared a distributed a handout on what happens to a nursing home with a provisional license. "I'm not emailing you this information because I kind of don't want Bernie to get it," she stated. "But I know he will."
A handout at a public meeting of Northampton County Council is certainly something to which the public is entitled. But I already know what happens when a nursing home is downgraded a provisional license, which is a temporary license that lasts six months and can only be renewed three times.
According to the Pa Code, a nursing home with a Provisional III license can operate despite serious deficiencies. It must follow a corrective plan and timetable with the state DOH. Failure to correct can result in closure or the loss of the license. But Zrinski told Council last night that the "likelihood that Gracedale will close is very low."
On the bright side, Zrinski told County Council that Gracedale recently underwent its annual survey and did well. An email from Continuum of Care Director Tom Carson said there were five deficiencies, which he said is below the state average.
UPDATEd 2 PM - In a news release issued late this morning, the county denies Gracedale is closing (No one has suggested it is). In addition to what she told County Council last night, Zrinski states that "[c]orrecting individual findings is not enough. We must also examine the systems that allowed additional problems to occur and intend to hire a consultant to review policies, procedures, and resident care plans, strengthen our corrective actions, and help demonstrate lasting compliance. Our priority remains the safety and well-being of every resident.”
UPDATED 2:15 PM: Pa. DOH posts September 24 Deficiency - Nurse's Aide Accidentally Broke Resident's Foot. - The September 24 deficiency flagged by the state department of health has now been posted online. It is a "G" level deficiency, meaning one that resulted in actual harm to a resident.
According to a Nurse Aide Kardex (a concise, quick-reference worksheet that summarizes each patient’s essential care information in one place) a resident at Gracedale was non ambulatory and needed assistance of two staff members when getting in and out of a wheelchair. A nurse's aide who failed to read the Kardex and who did not even know what a Kardex moved a resident from the toilet to a wheelchair, and in the process that resident's foot was fractured. This aide was supposed to have had a shadow day with another aide, but there is no evidence that happened. The resident stated that the nurse's aide let her slide down causing her leg to get twisted. She further stated that more than one staff usually assisted her; but at that time, only one staff member assisted with the transfer.
According to DOH, the facility's negligence resulted in a serious injury to a resident.
