Minnesota Veterans Home Minneapolis

1
Minnesota Veterans Home Minneapolis

• Summary of Regulatory Actions
• July 2005 to April 2007

Presentation to Governors Veterans Long
Term Care Advisory Commission May 16, 2007
2
MVH is a Licensed only nursing home

• State license is issued by the Department of
  Health
• Regulations, inspections and regulatory actions
  are specified in Minn. Stat. Ch. 144A and
  Minnesota Rules, Ch. 4658
• MVH has 341 Nursing Home Beds and 161 Boarding
  Care Home Beds
• This Summary only addresses nursing home issues

3
Licensure vs. Certification

• State law requires full licensure surveys once
  every two years however MDH has authority to
  conduct more frequently
• Surveys are conducted by staff from the
  Licensing and Certification Program
• Complaint investigations are conducted by staff
  from the Office of Health Facility Complaints

4
Licensure vs. Certification

• Correction orders, not deficiencies
• No scope and severity determination
• A written plan of correction is not required
  facility must correct within the specified period
  of time

5
Licensure vs. Certification

• Reinspection is conducted after the time period
  for correction has passed
• If a correction order is not in compliance, a
  penalty assessment, not a civil money penalty
  is issued
• Fine amounts are specifically identified in the
  licensure rules

6
Licensure vs. Certification

• Fines start upon the facilitys receipt of the
  notice of noncompliance
• Fines accrue on a daily basis
• Fines range from 50 to 500 per day
• Fines stop when the facility submits a written
  notice of compliance
• Another reinspection is required within 3 working
  days

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US Department of Veterans Affairs

• The Minnesota Veterans Homes are also required to
  meet the provisions of federal regulations
  adopted by this agency
• Regulations are similar to Medicare regulations
• The Department of Veterans Affairs conducts
  surveys of these facilities

8
Survey History April 01 August 04

• April 2001 and August 2003 surveys were based on
  traditional licensure model
• Emphasis on physical plant and record review
• April 2001 3 correction orders, all related to
  dietary sanitation

9
Survey History April 01 August 04

• August 2003 7 correction orders
• 4 related to physical plant
• 1 related to background studies
• 1 for comprehensive assessments
• 1 for no individual abuse plans for some of
  boarding care residents

10
Change in Survey Approach

• August 2004 MDH informed MVH Quality Assurance
  staff that process was changing
• MDH would use approach closer to federal survey
  process
• MDH would use observation
• Stronger emphasis on resident care

11
Regulatory Summary, 2004-2005

• Late 2004, 4 OHFC reports
• 2 reports were substantiated physical abuse
• 1 report was substantiated emotional abuse
• 1 report inconclusive
• In 2005, 2 OHFC reports before survey
• 1 substantiated neglect
• 1 inconclusive

12
Regulatory SummaryJuly 2005 to April 2007

• Two full licensure inspections were conducted
• 16 onsite OHFC investigations were completed 7
  investigations were substantiated
• A total of 66 correction orders were issued and
  11 penalty assessments were issued
• Fines totaled 42,300

13
Regulatory SummaryJuly 2005 to April 2007

• The 66 correction orders cited 54 different rule
  or statutory violations
• 35 of the violations were nursing or care related
  issues
• 7 of the violations were quality of life or
  resident rights issues
• 8 of the violations related to sanitation or
  physical plant issues
• 4 of the violations were miscellaneous-records
  keeping issues, reporting requirements

14
2005 Regulatory Actions

• Full licensure survey-July 26-29, 2005
• 28 correction orders were issued on August 29th
• 16 orders identified quality of care or quality
  of life concerns
• Improper restraint use
• Nursing care for proper repositioning of
  residents, required checking of incontinent
  residents, poor oral care, and grooming concerns
• Inadequate numbers of staff and
• Failure to treat residents with courtesy and
  respect

15
2005 Regulatory Actions

• 8 orders identified concerns with improper
  completion of incident reports, inadequate care
  plans, poor infection control, unlocked
  medication carts
• 4 orders identified sanitation and physical plant
  violations

16
2005 Regulatory Actions

• August 5, 2005- Complaint report issued
• 4 Correction orders issued
• Poor positioning of residents
• Poor care to incontinent residents
• Staffing concerns
• Grooming concerns

17
2005 Regulatory Actions

• November 6, 2005-Reinspection
• 23 orders were corrected
• 6 orders were not corrected
• 1 order was not due for reinspection
• 3 penalty assessments were issued
• 2 new correction orders were issued

18
2005 Regulatory Actions

• Penalty assessments were issued on December 6th
• Failure to comply with incident reporting
  requirements
• Infection control concerns
• Not following resident care plans

19
2005 Regulatory Actions

• Correction orders were issued on December 6th
• Not following resident dietary preferences
• Concerns with medication administration

20
2005 Regulatory Actions

• December 8th Notice of correction was received
• December 12th- Reinspection conducted and
  correction verified for both items assessed and
  the new correction orders
• Total fines- 1,400

21
2006-2007 Regulatory Actions

• November 12-17, 2006-Full licensure survey
• 26 Correction orders were issued on December 7th

22
2006 2007 Regulatory Actions

• 13 orders related to the delivery of nursing
  services
• Inadequate nursing assessments
• Inadequate care planning
• Inadequate nursing care rehab svcs.
• Pressure ulcer care
• Incontinence care
• Activities of daily living

23
2006-2007 Regulatory Actions

• Additional orders included
• Coordination between nursing therapy
• Medication errors
• Resident rights issues
• Activity program
• Infection control
• Housekeeping and maintenance

24
2006-2007 Regulatory Actions

• Areas of improvement from 2005 survey
• No findings related to restraint use
• No findings related in poor dental care
• No findings about insufficient numbers of
  staffing
• Improved kitchen sanitation and maintenance of
  physical plant

25
2006-2007 Regulatory Actions

• December 5, 2006-OHFC report issued which
  substantiated neglect due to lack of proper staff
  supervision
• Resident was injured in altercation in a smoking
  lounge
• Correction orders were issued regarding proper
  nursing supervision

26
2006-2007 Regulatory Actions

• February 26th 2007 OHFC reports were issued
• Neglect was substantiated relating to failure to
  adequately monitor diabetic status of a resident
  who died
• Neglect was substantiated as the result of
  improper medication administration

27
2006-2007 Regulatory Actions

• February 27, 2006 Reinspection
• 26 correction orders were in compliance
• 6 orders were not corrected

28
2006-2007 Regulatory Actions

• March 7, 2007
• 6 Penalty Assessment were issued
• Failure to properly implement care plans
• Failure to adequately provide range of motion
• Failure to adequately provide care to minimize
  pressure ulcers
• Medication errors
• Resident rights concerns
• Failure to properly report allegations of neglect

29
2006-2007 Regulatory Actions

• March 7, 2007
• 3 new correction orders issued
• Concerns with adequate and proper nursing care
• Labeling of drugs
• Development of abuse prevention plans

30
2006-2007 Regulatory Actions

• March 27, 2007-Notice of correction of the
  penalty assessments was received
• April 2, 2007-Reinspeciton was conducted
• The 6 penalty assessment violations were
  corrected
• 2 New penalty assessments were issued for failure
  to comply with the March 7th orders relating to
  medication labeling and provision of adequate
  nursing care

31
2006-2007 Regulatory Actions

• April 6, 2007 Notice of correction of the 2
  penalty assessments was received
• April 12, 2007 Reinspection was completed and
  the facility was found in compliance
• Total fines 40,900