VIRGINIA BEACH, Va. — The federal government is taking extreme and rare action against a Virginia nursing home for failures to meet health and safety standards. According to federal records, the facility in question is connected through common operational control to several other low-quality facilities in the Richmond region.
Inspection reports detailed repeated incidents of residents at the facility getting seriously hurt or being put at risk of injury due to lacking supervision, care, and services provided by staff.
Princess Anne Health and Rehabilitation Center in Virginia Beach was served with a notice that, as of August 27, its Medicare and Medicaid provider agreements are terminated.
It's the first time in at least the last three years that a Virginia nursing home has become federally decertified, according to the state Medicaid agency, and it's a measure that the government views as a "last resort" when problems persist at a facility without remedy.
“It's extremely rare for a nursing home operator to have their provider agreement removed," said Richard Mallot, the executive director of the Long Term Care Community Coalition, which tracks nursing home performance metrics and enforcement actions across the country.
The Centers for Medicare and Medicaid Services (CMS), which regulates nursing homes at the federal level, announced in a public notice that the termination was due to the facility's "failure to meet Medicare’s basic health and safety requirements." In order to receive government funding, facilities are required to comply with regulations that set standards for care. The Virginia Department of Health (VDH) performs inspections and complaint investigations on behalf of CMS to hold facilities accountable to those standards.
Mallot explained decertification typically only happens when a facility is cited with violations and does not correct them in a timely manner. Nursing homes generally have six months from the time they receive citations to implement corrective actions and are given multiple opportunities to regain compliance.
“What this really indicates to me is that a tremendous amount of bad things have gone on in this facility for a long enough period of time that the government has said, ‘Okay, we're going to do the last possible thing we can do to save residents and to protect the community,'" Mallot said.
He said a CMS termination could put a facility at risk of shutting down by making it financially difficult to continue operating.
“They're not officially closed, but they're not allowed to take Medicare/Medicaid funds, and Medicare and Medicaid funds take up or account for the large majority of monies that nursing homes get," Mallot said.
All current Medicare and Medicaid residents will need to be transferred to other facilities over the next 30 days.
Regarding the termination, facility spokesperson Mindie Barnett told CBS 6 in a statement, “Princess Anne Health and Rehabilitation Center is working diligently with state and federal regulators at the facility to be in full compliance and avoid any termination which would result in the disruption of essential care as well as loss of jobs in our community.”
When asked to provide the recent inspection reports that led to Princess Anne's decertification, VDH said it could not provide them due to an "active and open investigation." However, CMS provided the reports to CBS 6, and they contained several violations that resulted in harm, substandard quality of care, and/or immediate jeopardy — which are the most serious citations facilities can receive.
In February, the facility was cited for inadequate supervision after inspectors said a resident was found by a family member alone in her room "bleeding profusely" with "blood-soaked" clothes in the sink after falling and sustaining a "significant injury." Turns out, the resident had eloped, but staff didn't know, reportedly did not provide any care or treatment, and did not immediately call emergency services. Inspectors said the resident was required to wear a wander guard bracelet, which would monitor the resident for elopement, but the facility never applied one.
In another instance of inadequate supervision, inspectors said a family member found a different resident bruised and lying on the hot asphalt on the side of the road outside of the facility. He sustained a "severe head injury." Inspectors cited a failure of staff to assess whether the resident should've been allowed to walk outside independently.
Then there were also violations for failing to treat pressure ulcers, also known as bed sores, and prevent them from worsening. Inspectors said one resident developed two wounds just five days after admission. Inspectors said the facility was missing several days of wound care documentation and that interventions were "vague" and "not patient centered."
Nurse aides told inspectors “they often were unable to turn and reposition residents every two hours due to staffing shortages” and “sometimes did not feel good about the care they provided because they did not have enough help.” The nurse aides were reportedly "very hesitant" to speak to inspectors and asked to remain anonymous.
Then in June, a follow-up inspection resulted in five repeat violations, meaning the facility failed to implement corrective actions that would've cleared the violations previously cited in February. There was another inspection in August, but the facility received even more serious violations.
During that investigation, inspectors said the facility again failed to supervise a high fall risk resident who fell and became "severely injured," unresponsive, and required hospitalization in the ICU. The report noted staff further neglected to respond to the resident's worsening condition after the fall as she complained of intense pain. Despite acknowledging the resident likely suffered a fracture, a nurse only gave her Tylenol and did not immediately transfer her to an emergency room.
Inspectors said the facility's "oversight" caused the resident's hypotension secondary to trauma, fractures, and admission to the ICU.
In another incident during the August inspection, the report stated the facility failed to provide two staff members necessary for providing hygiene care to a resident. That caused a nurse aide to roll the resident off the bed, resulting in injuries requiring hospitalization. Inspectors could not reach the nurse aide for interviews and reported information from other staff members that the administrator threatened staff with losing their jobs if they talked to inspectors.
Princess Anne has an overall 1-star quality rating from Medicare, and ownership is currently listed under the Lifeworks Rehab chain and previously listed under the Medical Facilities of America (MFA) chain. A sign outside the building identifies an association with MFA. MFA nursing homes were acquired in 2021 by New Jersey-based company Innovative Healthcare Management, according to VDH.
Under the same portfolio are several nursing homes in Central Virginia that have recently experienced serious quality issues including Colonial Heights, Henrico, Westport, Parham, and Glenburnie. All facilities have 1-star overall quality ratings, with the exception of Henrico Health and Rehab. Henrico currently has no quality ratings because it has been identified as Virginia's worst-performing facility and was enrolled in a special oversight program.
Barnett has previously denied that Lifeworks or MFA act as owners or operators and instead referred to them as vendors.
Mallot called nursing home ownership, which he said makes decisions about how money is spent and how resources are prioritized, the "most significant problem" in the industry right now.
“That really does come down to, at least practically speaking, to the states doing a meaningful job in vetting companies that are coming in and buying facilities," Mallot said.
State Health Commissioner Dr. Karen Shelton has previously told lawmakers that VDH does not have authority to collect important information from companies applying for nursing home ownership, such as their regulatory history running other facilities or past lawsuits.
When asked whether VDH would take state-level action against Princess Anne's license, an agency spokesperson said, "The Virginia Department of Health (VDH) is considering all options in accordance with its legal and regulatory responsibilities to ensure appropriate care is provided to our most vulnerable Virginians."
Separate from federal enforcement actions, the state health commissioner has authority to suspend or revoke a nursing home's license and restrict admissions.
There are currently 30 Medicaid members at Princess Anne who will need to be transferred, according to the Department of Medical Assistance Services (DMAS). It's unclear how many Medicare members will be impacted. Payments for those residents will cease 30 days after the termination on September 27.
VDH said it's the facility's responsibility to relocate impacted residents.
The termination of the provider agreement isn't the first enforcement action against Princess Anne. In early May, CMS notified the nursing home that it was imposing a daily fine of $1,060 beginning Feb. 27 and would deny Medicare and Medicaid payments for all new admissions beginning May 27.
According to DMAS, five Medicaid patients were admitted to Princess Anne after May 27, despite the denial of payments being in effect.
"DMAS has directed its Managed Care Organizations (MCOs) to suspend payment for the five members who were admitted after that date and begin to transition them to other facilities," a DMAS spokesperson said in a statement.
It's unclear why Medicaid patients continued to be admitted after May 27. CBS 6 has asked DMAS whether Medicaid paid for those residents over the past few months and is awaiting a response.
When asked whether Princess Anne could become recertified in the future, VDH said the facility "could apply for certification as a new facility, followed by an initial certification process, and 30 days of providing care to residents."
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