One nursing home repeatedly allowed a resident to leave a facility to visit an abusive boyfriend. Another home failed to properly report and investigate many instances of residents' bruises, abrasions and allegations of abuse by staff. Other homes had trouble with cleanliness, odors and flies.
The Centers for Medicare and Medicaid Services (CMS) inspects and rates nursing homes that receive federal funds. Of the 111 nursing homes in the seven-county metro area evaluated by CMS, I've listed the 10 cited for the most violations between June 1, 2009, and Aug. 31, 2012, the past three CMS reporting periods. CMS has used three years of inspection data to rate nursing homes.
Many but not all of the deficiencies identified in the most recent reports have been described, as well as complaints substantiated by the Minnesota Office of Health Facility Complaints during the three-year period.
1 Crystal Care Center, Crystal, 62 violations
Failed to ensure a grab-bar met requirements; develop care plans for all residents; take an incontinent resident to the toilet on schedule; provide proper bed-sore treatment; date-mark opened medication and food; clean ovens; keep emergency call lights in working order.
2 Southside Care Center, Minneapolis, 51 violations
Failed to notify a physician and pharmacist of a client's condition; investigate or report instances of resident abuse, neglect or mistreatment; provide sanitary bathrooms; monitor the diet of a diabetic resident; monitor a resident's pulse; adequately staff nurses; have an infection-control program.
3 Golden Livingcenter - Lynwood, Fridley, 48 violations
Failed to fully document a complaint; get signed physician orders when a resident was transferred; maintain a sanitary, odor-free and comfortable facility; maintain a resident's "highest well being"; manage a resident's medications; control a fly problem.
Substantiated complaints: The home failed to notice when a resident cut off his wander bracelet and left the facility. It sent a resident to a clinic with a fever and a coccyx ulcer covered with feces. The resident was diagnosed with sepsis.
4 Presbyterian Homes of Arden Hills, 44 violations
Failed to immediately report and investigate an abuse allegation; fully develop a care plan for a resident at risk of pressure ulcers; monitor the diet of a diabetic resident; supervise a resident with balance issues; make sure a resident was hydrated; minimize risk of infection in the facility.
5 Woodlyn Heights Healthcare Center, Inver Grove Heights, 43 violations
Failed to address resident's complaints quickly; treat all residents with respect and maintain their dignity; treat or prevent a resident's pressure ulcers; train staff in safe procedures for transferring residents between bed and wheelchair; establish some care plans and implement others; provide adequate nurse staffing; maintain a sanitary kitchen.
6 Texas Terrace Care Center, St. Louis Park, 42 violations
Failed to serve food consistent with dietary requirements or preferences; maintain a sanitary facility; monitor a resident's weight; keep emergency call lights in working order.
Substantiated complaints: Staff failed to administer an antibiotic as prescribed. A resident died after staff improperly reacted to his low oxygen-saturation rate.
7 Golden Livingcenter - Chateau, Minneapolis, 42 violations
Failed to notify all residents prior to Medicaid benefits ending; treat residents with respect and maintain their dignity; maintain a sanitary facility; help a resident with grooming; supervise a resident adequately when his beard lit on fire while he was smoking.
Substantiated complaints: Offensive odors and inadequate housekeeping.
8 Camden Care Center, Minneapolis, 41 violations
Failed to develop policies to prevent abuse; neglect or mistreatment; neglected two residents who left the facility unsupervised and sustained injuries, and failed to immediately report the incidents; periodically assess a resident's functional capacity; develop a care plan for a resident with dentures or promptly deliver mended dentures; keep a refrigerator cold enough; maintain the facility in a safe, clean and comfortable condition; provide regular job reviews.
9 Robbinsdale Rehab & Care Center, Robbinsdale, 40 violations
Failed to provide accurate medical records upon discharge; assess and intervene in a resident's poor oral hygiene; reposition a resident every two hours; monitor the efficacy of all residents' medication; have a pharmacist review medications; date-mark medications; store and prepare food in a sanitary manner; keep emergency call lights in working order; train staff on how to move a resident safely.
Substantiated complaints: Facility let an unlicensed person dispose of medications.
10 Crest View Lutheran Home, Columbia Heights, 39 violations
Failed to immediately report or thoroughly investigate allegations by residents of being slapped by staff and numerous instances of bruises and abrasions. Failed to fully assess the behavior and abilities of residents; develop care plans; provide for residents' highest well being; prevent pressure ulcers; honor a resident's request to go to the toilet until it was too late; make sure residents were safe from burns; or explain the benefits and risks of flu shots.
Substantiated complaints: Failed to transcribe a doctor's order that a resident wear an arm sling.
Hard Data digs into public records and puts a spotlight on rule breakers in Minnesota. Contact me at firstname.lastname@example.org.
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