HENRICO COUNTY, Va. — When state inspectors entered a Henrico County nursing home in late August, they were met with a dead cockroach upon entrance, a strong smell of urine just beyond the lobby, and flies and gnats throughout the building — indicating a pest problem that inspectors already directed the facility to fix just a few months prior.
Inspectors would then find a woman in bed who had been “soaked in a brown halo of partially dried old urine" for several hours while surrounded by an odor of urine and feces that "permeated the room and the entire unit."
Those findings are according to reports from the Virginia Department of Health (VDH) during its most recent cycle of inspections of Parham Healthcare and Rehabilitation Center.
“It's not fit for man or animal," Maurice White said about the conditions at Parham. He's a current resident who said his wound became infested with maggots over the summer— allegations that are still under investigation by police. “It’s terrible Mr. Layne, and something needs to be done about it.”
Watch: Man says his wound became 'infested' with maggots at Henrico nursing home
According to Medicare records, Parham is a for-profit facility with a 1-star overall quality rating. A sign outside the building indicates an association with the Medical Facilities of America chain, and staffing levels at the nursing home are reported by Medicare to be "much below average."
“It's hard to get any help here. After seven o'clock, you can ring that call bell, and it might be an hour and a half, two hours before they come," White said.
Inspection findings: Bed sores, abuse, biohazards
In April, an inspection, also known as a survey, by VDH resulted in serious violations of care and safety standards including a failure to treat and prevent bed sores. One resident reported he got a pressure ulcer on his bottom because "they were short staffed" and did not turn or reposition him every two hours.
VDH inspectors also cited five instances of residents being allegedly assaulted by another resident who had a history of mental health issues, incarceration, and homelessness.
“Facility staff failed to prevent repeated willful abuse at the hands of residents and staff members," the inspection report said. "The facility further failed to report the abuse to the state agency accurately and timely, failed to fully investigate the abuse, failed to protect new victims from abuse, and further failed to implement their abuse and neglect policies."
Inspectors stated "there was never any ongoing added staff supervision" of the alleged abuser "to prevent the continuing known abuse from occurring." At one point, the alleged abuser was arrested at the facility on unrelated charges and incarcerated for about a week. He was brought back to the facility and nine days later, he assaulted his new roommate who had just been admitted that day.
Other citations included exposing residents to biohazards, not providing showers, and failing to keep the building free from pests.
“This place is infested. They got roaches. They got plenty of ants," White said.
After the inspection, the Centers for Medicare and Medicaid Services (CMS) began denying payments for new Medicare and Medicaid admissions, imposed a one-time of $93,000, and then a continuing fine of $650 for every day the facility remained out of compliance.
While VDH was expected to do a follow-up survey within 60 days in accordance with CMS guidelines, it didn't get back to Parham until late August. When asked why the agency was late, a spokesperson said inspectors needed to first complete an environmental safety inspection and "other steps needed to be completed and finalized before the revisit could occur."
Timely follow-up inspections are critical to ensuring that all previously cited violations have been corrected and critical to ensuring nursing homes have enough time to regain regulatory compliance before their Medicare and Medicaid provider agreements are terminated, which is a "last resort" enforcement action that could put a facility at risk of closing. Parham's termination date was slated for October 28.
A follow-up inspection
During the revisit inspection, VDH found a dependent woman lying in her bed who was "uncomfortable" and "wet from head to toe." Her body and bed smelled strongly of urine, and her room and entire unit smelled like feces. Partially dried urine surrounded her body "from her knees to her mid back," and her bed was soaked "with a permanent divot in the area directly under her bottom that did not spring back into place when she rolled off of it onto her side."
The woman laid in her waste for nearly four hours, and throughout the multi-day survey, she was never seen out of her bed during the daytime hours. She told an inspector that "there just were not enough staff to take care of residents" and that "this situation happened to her often."
Inspectors further noted that "residents were not being bathed and given hygiene timely, nor as often as needed" as they were observed "being soiled with dirty linens and clothing."
VDH did not cite these findings as a high-level violation that caused harm, which puzzled Richard Mollot, a long-time researcher of the enforcement system with the Long Term Care Community Coalition, who reviewed the survey report. CMS typically, but not as a standard, does not impose enforcement actions for violations that aren't cited at a harm level.
“The fact that they didn't identify this as harmful is troubling on a human standpoint, just that recognizing this person was clearly harmed. We would not allow them to do this to a child, to a dog, etc," he said.
The pest problems at Parham were still not resolved by the revisit, with inspectors finding flies, ants, gnats, and cockroaches throughout the building.
During the survey, an inspector heard a resident cry out for help after an upper closet door fell and hit her, causing three abrasions to her face. The inspector ran over to find the resident trembling and shaken.
Upon further investigation, inspectors discovered the closet door was not screwed in and the closet itself was infested with cockroaches. The resident was taken to a hospital, but it was determined she did not suffer serious injuries or fractures.
Inspectors faulted the facility because it "knew or should have known that the closets were a hazard and did not act quickly enough to mitigate the hazard resulting in a minor injury requiring only first aid." VDH again did not cite this violation as causing harm.
“Here we see, even when they find really significant lapses, they fail to identify that in a way that is going to be meaningful," Mollot said. "It's striking that they would think that this is not extremely serious."
VDH cited the closet door "hazard" as an environmental condition violation as opposed to an accident hazard violation. CMS guidance states an accident hazard violation should be used when a facility fails to "identify and eliminate all known and foreseeable accident hazards in the resident’s environment."
The agency did not answer questions about its method and reasoning for citing violations but said in a statement it "remains committed to ensuring that quality healthcare is provided by medical care facilities that is safe and compliant with state and federal laws."
Facility regains compliance, 'proud of progress'
Because VDH's revisit inspection did not result in new high-level violations or repeat violations that were previously cited at a high severity level during the April inspection, another on-site inspection was not required but rather discretionary. The most severe citations from the April inspection were an accident hazard violation and an infection control violation.
VDH accepted a plan of correction from the facility and completed an off-site revisit, meaning it reviewed documentation submitted by the facility but did not physically return to the facility in order to check for compliance with the plan of correction.
In a letter dated October 6, VDH deemed the facility back in regulatory compliance and said it would notify CMS of that status.
“Parham Healthcare and Rehabilitation Center is proud of the progress we have achieved and continues to remain committed to providing quality care in the community," facility spokesperson Mindie Barnett said in a statement.
CMS did not respond to questions for this story. An email for an agency spokesperson returned an automatic message stating he would be out of the office during the government shutdown.
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