No state fines for nursing home with black mold, sleeping workers and no nurse on duty

No state fines are being imposed against an Iowa nursing home where employees slept on duty, where a resident had to call 911 for medical assistance, and where widespread mold was uncovered last month.

After fielding seven complaints about conditions at the QHC-Mitchellville nursing home in Polk County, state inspectors visited the home in July and August and concluded the 44 residents who lived there were in immediate jeopardy.

The Iowa Department of Inspections and Appeals ultimately cited the home for 10 violations of federal regulations and eight violations of state regulations, and proposed, but did not actually impose, a fine of $36,750. The state fine is being held in suspension while the Centers for Medicare and Medicaid Services considers the imposition of federal fines. The state has the option of imposing fines if CMS fails to act.

Last year, the home was fined $156,003 by the federal government as a result of three separate state inspections.

Among the problems noted by DIA’s inspectors during their August visit to the QHC home:

— Resident calls 911

After a resident complained to the staff that she was worried about fluid in her lungs, a nurse examined the woman and allegedly said no emergency intervention was needed. Later that same day, the resident dialed 911. The fire department responded, but the QHC staff told the medics the woman who summoned them was “doing well” and was merely complaining. The medics assessed the woman’s condition and transported her to a hospital where she was admitted for five days and treated for a virus.

— Staff sleeping on duty

The home was cited for insufficient staff, with one resident telling inspectors that one of the night staff routinely sleeps during his or her shift and had set up a bed in the front lobby for that purpose. Another resident reported seeing workers sleeping in the home’s dining room.

At 3:30 a.m. on July 15, an inspector watched as one employee reclined in a chair, in the dark, with a chair positioned in front of her to serve as a footrest. The worker’s shoes were off, her eyes were closed, she had a blanket pulled up to her chin, and a fan was positioned nearby to blow on her. At that point, another worker, wearing no shoes, walked out of a nearby darkened office where two chairs had been positioned to face each other with blankets over the top of them.

A resident, seated nearby in a wheelchair, told the inspector, “See? I told you.”

The home was cited for placing residents in immediate jeopardy but one day later that violation was downgraded in light of the home’s plans to educate the staff on the need to remain awake at work.

— Toxic mold

Areas of the home appeared to have sustained water damage and mold growth due to a leaky roof. Inspectors observed peeling wallpaper near the ceiling, as well as large sections of ceiling tile that were stained brown. Windowsills were reported by inspectors to be “rotted, mushy and unpaintable,” and drywall was reported to be “soft and squishy.”

When the outer paper layer of the drywall was pulled back in one room, it revealed a black, mottled area that suggested mold was present. In other areas of the building, inspectors found cracked windowpanes, a rotted windowsill, and soft, peeling drywall.

Ten residents of the home were immediately relocated to other rooms, with priority given to residents in rooms with confirmed stachybotrys – better known as toxic black mold, which can cause severe respiratory problems and contribute to fatigue and depression.

The home had employed no maintenance staff for eight months, inspectors found. A “remediation technician” later found mold in 80% of the building, including walls, ceilings, air conditioners, the kitchen and residents’ rooms.

A more detailed analysis indicated the mold had been present for at least a year and that nine resident rooms as well as some common areas, were considered “Level 2” or “red” zones, indicating a need for full enclosure of those areas to prevent the movement of air.

An additional 15 resident rooms were categorized as “Level 1” or “yellow” zones that needed to be isolated from other areas and treated for mold. Corrective action could take eight months, the administrator told inspectors, and the owner reported that workers would be outfitted with full, protective white suits to wear during the clean-up.

The home was found to have placed residents in immediate jeopardy, but DIA officials considered the jeopardy to have been “removed” four days later with the hiring of a mold remediation company, and so the seriousness of the violation was downgraded.

— Inspector alerts aide to resident’s high fever

While at the facility, an inspector noticed a resident who appeared to be running a temperature and was in distress. An aide said she was unsure of the resident’s temperature as it had not been checked. With the inspector present, the resident’s temperature was measured at 106 degrees. A nurse was called to the room and an ambulance was summoned. The resident was admitted to a hospital with a diagnosis of sepsis – a potentially life-threatening infection – and acute kidney failure.

— No licensed nurse on duty

The facility had no licensed nurse on duty for three and a half hours on June 25. As a result, one resident was not given a prescribed intravenous antibiotic, two others were given insulin by an aide not licensed or authorized to provide injections, and two others didn’t have wound dressings changed as ordered.

Medical records at the home indicated staff weren’t putting their initials on the records to document who was providing care, and in some cases, it appeared that care documented in the records wasn’t actually provided by anyone.

— Bed sores left untreated

Over a period of four months, the home repeatedly failed to treat a resident’s bed sores, which resulted in the wounds growing deeper and doubling in size. The home’s director of nursing told inspectors she knew that if a resident’s wounds grew worse, the resident’s physician should be contacted, but stated she “just did not do it.”

— Resident’s breathing tube clogged

The home was found to have placed one resident in immediate jeopardy by failing to have the necessary emergency equipment accessible to clear the resident’s tracheostomy tube so she could breathe.

After the woman’s breathing apparatus was found to be “plugged with hard, caked secretions” from not being cleaned, she was taken to a hospital emergency room for treatment. One day after determining the home had placed the woman in immediate jeopardy, state inspectors downgraded the violation because the resident decided to relocate and the staff was educated.

Federal agency reduces penalty

In January 2020, CMS fined the home $78,125, but reduced that penalty by 35% when the home agreed not to file an appeal. The final penalty was $50,781. A proposed state fine of $18,000 was not imposed.

In May 2020, CMS fined the home $48, 279. A proposed state fine of $30,500 was not imposed.

In September 2020, CMS fined the home $56,943. A proposed state fine of $3,000 was not imposed.

State records indicate QHC is a for-profit, limited liability company that owns and manages the Mitchellville home. There are other QHC care facilities in Fort Dodge, Humboldt and Winterset.

A QHC representative working out of the company’s Des Moines office did not respond to calls Monday from the Iowa Capital Dispatch.