Five local homes with the lowest deficiency rates
1. Heartland of Greenville, 1 deficiency, 0.12 deficiencies per 10 residents.
2. Heartland of Miamisburg, 1 deficiency, 0.12 per 10 residents.
3. Birchwood Care Center in Hamilton, 1 deficiency, 0.14 per 10 residents.
4. Otterbein Lebanon Retirement Community, 4 deficiencies, 0.17 per 10 residents.
5. Bethany Lutheran Village, 5 deficiencies, 0.20 per 10 residents.
Five local homes with the highest deficiency rates
1. Ridgewood Nursing and Rehabilitation Center in Springfield, 32 deficiencies, 8.9 per 10 residents.
2. Parkside Nursing and Rehabilitation Center, Fairfield, 47 deficiencies, 7.01 per 10 residents.
3. Four Seasons of Dayton Nursing and Rehabilitation Center, 31 deficiencies, 6.33 per 10 residents.
4. Astoria Health & Rehab Center, Germantown, 25 deficiencies, 6.1 per 10 residents.
5. Liberty Nursing Center of Oxford, LLC, 35 deficiencies, 6.0 per 10 residents.
Source: U.S. Centers for Medicare and Medicaid Services
Who to call for help
To contact the Dayton-Montgomery County Ombudsman’s office, call 1 (800) 395-8267, or go to the ombudsman’s website, http://www.dayton-ombudsman.org/ and click on “Make a Complaint”.
Official complaints can also be lodged with the Ohio Department of Health’s Division of Quality Assurance. The division can be reached at 1 (800) 342-0553, or by email at HCComplaints@odh.ohio.gov. It’s mailing address is Ohio Department of Health, Complaint Unit, 246 North High Street, Columbus, OH 43215.
The Dayton Daily News obtained and analyzed inspection data from the U.S. Centers for Medicare and Medicaid Services on 940 Ohio nursing homes. The newspaper then ranked the facilities based on a deficiency rate — the number of deficiencies or citations per 10 occupied beds. The rate normalizes facilities of different sizes, allowing a fairer comparison.
Which Ohio nursing homes have performed worst? Best? Our interactive chart and searchable database have information on Ohio’s 940 nursing homes at MyDaytonDailyNews.com.
Nursing homes in the Dayton region have a better inspection record than the state as a whole, but an analysis of three years of state data by this newspaper found serious violations occurring in local homes, including sexual assaults, physical abuse, medication errors and lack of necessary care.
The data, compiled by Ohio Department of Health inspectors for the federal government, show the Miami Valley has some of the state’s top-performing nursing homes when ranked by the number of citations, called deficiencies, per resident.
Five of the 20 Ohio homes with the lowest deficiency rates, and thus the best rankings, are in the Miami Valley.
But the investigation also found that serious infractions can occur even in highly rated homes, and a single incident — even in a large home — can mar a home’s ranking.
That happened in July 2011 at Friends Extended Care Center of Yellow Springs, when a nurse sexually assaulted a female resident. That assault yielded three “immediate jeopardy” deficiencies — the state’s worst category — that have tarnished the home’s record, said Karl Zalar, executive director of the home.
“We’ve had to live with that — one person’s actions — for now going close to three years,” Zalar said. “But it doesn’t tell the complete picture with what is truly going on in this building.”
The nurse, Kevin L. Burns, 44, of Browersville, was sentenced two months later to nine years in prison for the rape.
Zalar said the nursing home did its due diligence in conducting state and FBI background checks on Burns. “He had an excellent reputation in his community, in his church, etc., so we had no indication,” Zalar said.
The facility spent $27,000 on security devices, including walkie-talkies for all employees, and did extensive training on abuse reporting and security, Zalar said.
“It’s that one day, that one person, which really has put a cloud over a very dedicated group of people who have worked in this facility.”
In fact, Friends has received just four deficiencies, none in the most serious category, since 2011. Overall, the home has 15 deficiencies during the three years for a rate of about 2.6 infractions per 10 residents. It has, however, incurred $38,350 in fines during the period.
More than 16,000 deficiencies
During a three-year period ending on Feb. 27, 940 Ohio nursing homes with 76,500 occupied beds amassed 16,005 deficiencies and paid fines of $4.5 million.
The 124 nursing homes in the nine-county Dayton-Springfield region — which had 10,500 residents — incurred 1,594 deficiencies and paid $712,000 in fines.
The local homes averaged four fewer deficiencies than the state as a whole — 13 deficiencies per home compared to the state’s 17. And the region’s deficiency rate — 1.5 for every 10 occupied beds — was also better than the state rate of 2.1.
The deficiencies are recorded during unannounced annual inspections and other inspections spurred by complaints. The deficiencies are ranked in seriousness depending on how much they affect residents’ health and well being, and how many residents they affect.
During the three years covered in the data from the U.S. Centers for Medicare and Medicaid Services, state surveyors found 79 violations classified as constituting “substandard care” in the region, and 19 that presented “immediate jeopardy” to one of more residents. Statewide, inspectors found 982 substandard care violations and 107 more serious deficiencies.
The most frequent violations include failing to monitor residents properly, ensuring that they are taking the right drugs and providing adequate supervision to prevent accidents and falls.
“It becomes immediate jeopardy if it’s a situation in which if immediate action isn’t taken, the facility’s noncompliance has caused or is likely to cause serious injury, harm, impairment or death to a resident,” said Barbara Stewart, acting chief in the Ohio Department of Health’s Bureau of Long Term Care Quality.
‘It is neglect’
Serious problems can happen even in highly rated facilities, the investigation found.
Bethany Village in Centerville has one of the best records in the state. One of the largest nursing homes in Ohio, the sprawling, 100-acre campus housed 246 residents in state certified nursing home beds in its last inspection, but has received only five deficiencies during the three years.
Unfortunately, three of those resulted in a 2011 sexual assault on a resident perpetrated by the husband of an employee. David H. Howson, 64, of Dayton was subsequently sentenced to five years in prison on one count of rape of a substantially impaired victim.
Bethany received an immediate jeopardy infraction for failing “to ensure staff immediately notified the Administrator and failed to immediately protect residents,” according to the state inspection report. That happened because the wife of the rapist, whom the victim reported the assault to, did not report the accusation that night, and later told police she forgot about it.
More recently, in January of this year, the sister of a Bethany resident alleged that her brother, Brian Workman, 62, received negligent care that resulted in him losing a toe.
Leslie Workman, 58, of Beavercreek said she repeatedly asked about the use of a pressure hose on her brother, a diabetic, and asked that he be seen by a podiatrist.
The state inspection report, dated Jan. 18, 2014, states “the facility failed to ensure a resident received the proper foot treatment and care after it was determined the resident required specialized foot care.”
The report found that Brian Workman “was never seen by a podiatrist” although the podiatrist was in the facility four times during Workman’s stay.
“It is neglect,” Leslie Workman said. “It is neglect. The doctors and the nurses (in the hospital) said so. And when you saw his toe, you would know this.”
Officials from Bethany Village declined to be interviewed for this story.
In a prepared statement, Jackie D’Aurora, spokeswoman for Graceworks Lutheran Services, which sponsors Bethany, states that while it cannot comment on individuals or their care, the January citation “did not allege that any residents were harmed due to the facility’s actions.”
D’Aurora points out that the scope and severity rating for the deficiency was a “D”, in a scale of A, the least severe, to L, the most severe. The rankings J, K and L constitute what federal law calls “immediate jeopardy to resident health or safety.”
A “D” ranking is defined as “no actual harm with potential for more than minimal harm” not severe enough to be categorized as immediate jeopardy.
Bethany Village has prepared a plan of action as required by law, according to the statement.
D’Aurora states that Bethany Village exceeds the state average for staffing ratios, resident satisfaction surveys and other quality measures.
“The Ohio Department of Aging reports Bethany Village resident satisfaction at 94.07% and family satisfaction score of 88%,” D’Aurora wrote. “In fact, Nursing Home Compare, a website run by the Medicare and Medicaid departments, gives Bethany four stars for both staffing and quality measures.”
Springfield home tops area for highest deficiency rate
The area home with the highest rate of deficiencies per resident was Ridgewood Nursing and Rehabilitation Center in Springfield, the newspaper analysis found. Over the past three years, the for-profit home on Saint Paris Road had 32 deficiencies.
With just 36 residents at the time of its last inspection, Ridgewood had a rate of 8.9 deficiencies for every 10 occupied beds — 29th-highest among 940 nursing homes in the state.
Some of the citation reports include improper food storage, failing to provide catheter care necessary to prevent infection, failure to follow physician’s orders in implementing fall protection procedures, failing to keep flies out of the building, and multiple housekeeping and maintenance issues. None of the citations, however, were in the most serious immediate jeopardy category.
Ridgewood declined an interview for this story.
In a prepared statement, Ridgewood’s parent company, Extendicare Central Ohio, admitted that a November 2013 inspection “resulted in an unusually high number of deficiencies, which were addressed immediately and resolved to the satisfaction of the Federal government.” But it noted that the home received only six deficiencies in 2011 and three in 2012.
“Our staff is committed to responding quickly and completely to any deficiencies found during the survey process and we continually invest in resources to improve the care and services provided at our center,” the statement read. “Our primary concern is, and has always been, the health and well-being of our residents. We are confident that these practices have been corrected and addressed appropriately.”
The home with the highest deficiency rate in Ohio was Rosewood Manor, a relatively small nursing home in Yorkville. The Jefferson County home has 28 residents yet racked up 67 deficiencies during the three years, including 11 qualifying as substandard care. That gave it a deficiency rate of 24 per 10 residents, more than twice Ridgewood’s rate.
Only Vista Center of Boardman, which has 58 occupied beds, had more deficiencies than Rosewood Manor. The Mahoning County home incurred 71 deficiencies during the three years, including three qualifying as substandard care.
How to get help
Local advocates say there is help available for nursing home residents or family members who have problems with a facility.
Monica Wynn, director for the Long Term Care Ombudsman Program for Dayton and Montgomery County, said she knows residents are often reluctant to come forward.
“A person who is receiving services in a nursing home may be physically compromised, so speaking up for them could be a little difficult,” Wynn said. “They also might be afraid that if they speak up, they might not get the good care that they are expecting. So maybe retaliation could be a fear.”
Wynn said her office is there as an advocate for citizens. “We can be their voice in resolving the problem,” she said.
Family members should watch for whether residents are kept clean, how well the home communicates with the resident and the family, and if the care plan is being followed, Wynn said.
“Make sure that the resident, that person who needs care, is at the center of it, and is helping make those decisions and is getting their needs met as they need to be met,” she said.
Family members can also lodge complaints with the Ohio Department of Health’s Division of Quality Assurance. The health department’s Barbara Stewart said complainants don’t necessarily need documentation or hard evidence.
Those complaining will be asked “a lot of questions to help get enough information about what really went on and see if it is a regulatory issue,” she said.
“And then we go out and investigate.”
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