DARLINGTON - Lafayette Manor is now on a federal watch list for nursing homes with "a history of serious quality issues" following a state investigation this summer.
As part of this program, the facility must be inspected at least every six months. In addition, the Manor is facing potential fines and a loss of Medicaid and Medicare certification.
"The longer the problems persist, the more stringent the enforcement actions," said Stephanie Smiley, communications director at the Department of Health Services.
Reports from the state's investigation of five violations describe in detail, over dozens of pages, how Manor staff botched record-keeping and failed to follow through with recommended treatment plans.
Communication breakdown is a common theme across the case studies, which are based on state inspectors' visits and interviews in June and July. In repeated instances, the inspector found that staff did not reliably document or address family members' concerns, update physicians on medical developments or schedule appointments in a timely manner.
In one case, a daughter visited her father at Lafayette Manor in July and found him sitting in the lobby with no covering on his swollen, gangrenous foot and a puddle of drainage collecting on the floor underneath. Two days later, the daughter said his foot looked worse.
The inspector found evidence the man had been taken off an antibiotic too soon and against his daughter's wishes and treatment plan.
In another case, an 87-year-old man with open wounds on his foot did not get immediate treatment and developed wet gangrene as a result.
"Subsequent to discovering the wound, there is no evidence that the facility monitored his wounds or assessed the wounds on a daily basis or even weekly," wrote the inspector.
A family member told the state surveyor that when she saw his foot during a visit, she was "shocked to see it bright red, swollen and weeping."
When the inspector asked the Manor administrator "how this resident's skin issues were missed," Catherine Krentz answered, "You can't be everywhere all the time, I guess."
In the case of the daughter upset her father missed antibiotic treatments, the inspector concluded the Manor's documentation of this concern "reflects the facility being defensive about concerns and doing what they think is right instead of family wishes."
Krentz, who was suspended from her position last week, provided a "Plan of Correction" in August for each documented violation. These include educating staff and updating existing policies for clarity. The state accepted her plans and has since finished its latest investigation, according to Smiley.
The official findings of this investigation are not yet available, but the ramifications are already reverberating through the troubled facility, which in recent years has struggled with budget problems, controversial employee dismissals and a two-fold increase in state citations from 2010 to 2011.
The Madison-based consulting company Apara Care has already completed a state-ordered evaluation of the facility. The county committee that oversees the Manor is stalled in how to proceed with Apara's report, but it did put Krentz on administrative leave and replace her with Memorial Hospital's Sherry Kudronowicz in the meantime.
The state has recommended the Centers for Medicare and Medicaid Services terminate the Manor's participation in these programs Dec. 27 if the facility "is not in substantial compliance by that time." It also recommended "discretionary denial" of Medicare and Medicaid payment for new admissions to the Manor, effective Aug. 1, plus fines of $2,400 and $7,500 for two separate health violations.
David Halloran, chair of the Nursing Home Committee, says the Manor is working to fix the issues the state discovered.
"The surveyors are doing their job. It could be that adherence to prescribed policies had become a little lax," he said. "There are always efforts for retraining and efforts for re-education. You're never going to completely eliminate mistakes. We can all strive to do a little bit better."
As part of this program, the facility must be inspected at least every six months. In addition, the Manor is facing potential fines and a loss of Medicaid and Medicare certification.
"The longer the problems persist, the more stringent the enforcement actions," said Stephanie Smiley, communications director at the Department of Health Services.
Reports from the state's investigation of five violations describe in detail, over dozens of pages, how Manor staff botched record-keeping and failed to follow through with recommended treatment plans.
Communication breakdown is a common theme across the case studies, which are based on state inspectors' visits and interviews in June and July. In repeated instances, the inspector found that staff did not reliably document or address family members' concerns, update physicians on medical developments or schedule appointments in a timely manner.
In one case, a daughter visited her father at Lafayette Manor in July and found him sitting in the lobby with no covering on his swollen, gangrenous foot and a puddle of drainage collecting on the floor underneath. Two days later, the daughter said his foot looked worse.
The inspector found evidence the man had been taken off an antibiotic too soon and against his daughter's wishes and treatment plan.
In another case, an 87-year-old man with open wounds on his foot did not get immediate treatment and developed wet gangrene as a result.
"Subsequent to discovering the wound, there is no evidence that the facility monitored his wounds or assessed the wounds on a daily basis or even weekly," wrote the inspector.
A family member told the state surveyor that when she saw his foot during a visit, she was "shocked to see it bright red, swollen and weeping."
When the inspector asked the Manor administrator "how this resident's skin issues were missed," Catherine Krentz answered, "You can't be everywhere all the time, I guess."
In the case of the daughter upset her father missed antibiotic treatments, the inspector concluded the Manor's documentation of this concern "reflects the facility being defensive about concerns and doing what they think is right instead of family wishes."
Krentz, who was suspended from her position last week, provided a "Plan of Correction" in August for each documented violation. These include educating staff and updating existing policies for clarity. The state accepted her plans and has since finished its latest investigation, according to Smiley.
The official findings of this investigation are not yet available, but the ramifications are already reverberating through the troubled facility, which in recent years has struggled with budget problems, controversial employee dismissals and a two-fold increase in state citations from 2010 to 2011.
The Madison-based consulting company Apara Care has already completed a state-ordered evaluation of the facility. The county committee that oversees the Manor is stalled in how to proceed with Apara's report, but it did put Krentz on administrative leave and replace her with Memorial Hospital's Sherry Kudronowicz in the meantime.
The state has recommended the Centers for Medicare and Medicaid Services terminate the Manor's participation in these programs Dec. 27 if the facility "is not in substantial compliance by that time." It also recommended "discretionary denial" of Medicare and Medicaid payment for new admissions to the Manor, effective Aug. 1, plus fines of $2,400 and $7,500 for two separate health violations.
David Halloran, chair of the Nursing Home Committee, says the Manor is working to fix the issues the state discovered.
"The surveyors are doing their job. It could be that adherence to prescribed policies had become a little lax," he said. "There are always efforts for retraining and efforts for re-education. You're never going to completely eliminate mistakes. We can all strive to do a little bit better."