Code violations lack full context, nursing-home worker argues

By ALYSSA LENHOFF

TheNewsOutlet.org

This year, the average number of health-code citations in Ohio is six. The average in the United States is 7.5. In May, Maplecrest Nursing Home in Struthers received 22.

A quick look at just the numbers may leave an unfavorable impression, but the home’s director of nursing said there are stories behind these numbers — and not all of them are bad.

Theresa “Terri” Sebastiano, who has worked at Maplecrest for the past nine years, said she doesn’t blame inspectors for the citations they levied against the home. She just wishes the state would give the home credit for what she says are the good things it does.

State inspectors found fault for infractions ranging from not notifying physicians when patients’ conditions changed to not providing a dignified dining experience for the residents.

In terms of seriousness, two of the Maplecrest citations were classified with the letter “G” on the A-to-L federal scale, where L is the most serious. The “G” classification was for incidents where patients’ conditions worsened and state inspectors said the home failed to notify physicians of the changes.

Another incident related to the nursing home was not properly reporting or investigating a resident’s allegation that he had been abused.

One citation involved an incident in April when a resident on a blood thinner was bleeding and becoming lethargic. State inspectors said it took the nursing home several days to properly report the issue to the resident’s physician and to get appropriate blood tests performed.

In that same report, investigators documented problems with how the home handled a resident’s allegations that two nurses’ aides had treated him roughly and forced him to go to bed when he said he wasn’t ready.

The incident, which took place in May, was neither properly reported nor investigated, according to the report, and nursing-home officials pledged to handle such situations better in the future.

With 22 deficiencies, the May inspection was not the first time the home has had problems with the state. In 2010, inspectors found eight deficiencies; in 2011, there were nine, according to the Medicare website.

Several facilities in Mahoning County had more deficiencies than Maplecrest, including Valley Renaissance in Youngstown and Briarfield of Boardman (now Vista Care), each with 24; Greenbriar Center of Boardman with 21; and Pembrooke Place of Youngstown with 23. Pembrooke is also listed as a Special Focus Facility and has had fines and payment denials imposed against it by the U.S. Center for Medicare and Medicaid.

Sebastiano values the inspection process and believes it has led to better living and care conditions for the elderly.

“I think it’s really changed in the last four to five years. It’s gotten better,” she said. “We are one of the most-regulated industries in the country.”

Sebastiano said Maplecrest’s 2012 inspection marked the first time that state inspectors were using a new process, and that comparisons to other facilities that might have been inspected under earlier methods are not fair.

She also pointed out that Maplecrest has not had any “complaint” survey investigations in years. Complaint surveys, she explained, are generated by residents or family members who are unhappy about some aspect of life or care in the home. “Our residents are happy and well taken care of. They are like family to us,” she said.

Sebastiano and Jeanne Ellis, the other registered nurse who works at the facility, said some violations don’t reflect the true conditions at the home.

Ellis discussed the home’s May inspection and said the surveyors missed the mark on a few of the citations, including one where they said that Maplecrest staff were standing in the dining room during a meal. In order to provide a dignified dining environment, staff is supposed to be seated with the residents, Ellis said.

She said, however, there were so many state inspectors in the dining room that there were no places for the Maplecrest staff to sit. “They didn’t know if they should ask the inspectors to get up so that they could sit down,” Ellis said.

Ellis told the Maplecrest staff they should have asked the inspectors to give up their seats.

The incident involving the resident on blood thinner also was more complicated than the state reports revealed, Ellis said.

She said the way the home described the actions it took to notify the doctor was not as complete as it should have been. She said the doctor was notified in a timely manner, but that the documentation of that notification was lacking.

Sebastiano wishes the state would make nursing homes’ responses as public as the original citations. She also wishes there would be a way for state inspectors to report some of the positives at homes.

For example, she is proud of the bingo nights it offers, the trips to the Canfield Fair or to stores, the resident cat “Mushie” who roams the facility, and the meals served, which sometimes are based on residents’ own recipes.

Sebastiano believes the home’s residents and their families are happy with the quality of care there.

For example, there is Steve Roth who volunteers there on Mondays, Wednesdays and Thursdays. His wife, Edith, had been a resident of the home before dying of pneumonia in July.

“I am really happy with all of the love the nurses and nurses’ aides would show Edith,” Roth said. “I come here now as a sign of thanks.”

Roth rated his level of satisfaction with Maplecrest as a 10 out of 10. He had only one complaint.

“The food was the one thing I didn’t care for. They served a lot of sandwiches, and they would serve the same things for days in a row.”

The 48-bed nursing home, nestled in a residential neighborhood, stands in stark contrast to many of the area’s larger, corporate-owned facilities. It’s a distinction Sebastiano knows well.

Before coming to Maplecrest, she worked as the director of nursing for Greenbriar Center, a huge 120-bed facility in Boardman. “It was wonderful, too,” she said.

However, for Sebastiano, Maplecrest is special.

“Being privately owned allows us to meet residents’ needs — socially and physically,” she said, explaining that she does not have to go through a great deal of paperwork to order something for a resident when she thinks it’s warranted.

She said Maplecrest, owned by Chris and Lisa Daprile, is planning a $1.8 million expansion that would give the facility an opportunity to seek certification for seven more beds and give it more space for added programs, including a kitchen that residents and their family members could use and an expanded therapy center to include outpatient therapy.

When Sebastiano’s father, Angelo, a retired teacher and administrator with the Youngstown City Schools, was sick, she brought him to Maplecrest. Angelo Sebastiano lived at Maplecrest for one year before he died in March.

Kevin Alquist contributed to this report.

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