A Glen Burnie nursing home that repeatedly failed state inspections in the last two years could be shut down unless it corrects violations of at least 12 regulations.
North Arundel Nursing and Convalescent Center is on the brink of losing its Medicare and Medicaid support after state investigators found a continuing pattern of inadequate supervision, poor record-keeping, patient neglect and related problems.
A 35-page report detailing those findings and threatening to cut Medicare and Medicaid by Nov. 20 was released yesterday by the state Department of Health and Mental Hygiene.
Health officials, who inspected the private, 121-bed nursing home on Hospital Drive three weeks ago, documented more than a dozen times when nurses gave patients the wrong food or too much medication. Nurses also repeatedly failed to inform supervisors of patient injuries and sudden medical complications.
Investigators spent a week reviewing patient records and following nurses on their rounds after the center failed its annual inspection for the second year in a row. The home was cited in August for violating 36 regulations involving 39 patients.
Unless the center takes immediate steps to meet the regulations, it's likely to become ineligible for Medicare and Medicaid financing by Nov. 20, said Carol Benner, acting director of licensing and certification for the Health Department.
Those sanctions would seriously jeopardize the center's license to stay open, she said.
Benner sent a copy of the report and a letter recommending withdrawing the center's Medicare certification to the federal Health Care Financing Administration on Tuesday. Nursing homes must have Medicare backing to qualify as a Medicaid provider.
"To avoid the sanctions, they would have to come to us with a credible demonstration of compliance, and I must stress the word credible," she said in an interview. "They only really get two shots, and they've used one up at this point."
Shirley D. McKnight, the director of the 22-year-old nursing home who was faulted for failing to enforce the rules, said she's determined to correct the problems.
"We're doing all we can to come into compliance," she said. She declined to answer additional questions, although she told The Anne Arundel County Sun two weeks ago that the facility passed the follow-up inspection with flying colors.
McKnight previously blamed the nursing home's problems on poor record-keeping by nurses contracted from outside agencies. By replacing those nurses with a 26-member staff, she planned to bolster documentation.
But the inspectors found more serious lapses in care than just inadequate records. In their Oct. 30 report, investigators listed examples when "residents' physical conditions have been permitted to unnecessarily deteriorate due to the lack of appropriate and timely medical and nursing intervention . . . ."
One of the most serious cases involved the possible over-medication of a 74-year-old patient who had a history of hypertension and seizures. When she entered the center in early September, the report said, nurses did not notice conflicting records suggesting two different dosages of Dilantin, a drug commonly used to treat epilepsy.
The patient continued to receive too much Dilantin even after she complained of nausea and vomiting. She eventually was hospitalized with pneumonia and an electrolyte imbalance after nurses found her sluggish, gasping and rapidly losing blood pressure.
Investigators also discovered that patients on special diets often were given the wrong food. In a striking example, a patient whose meal tray clearly stated "no hot dogs" was served one for lunch. Other patients who refused food weren't offered a substitute.
Although the inspectors did not witness any patient abuse, several residents of the center complained they have been threatened, a source familiar with the investigation said. Others claimed they have been neglected by what they described as a harried and over-worked staff.
One man called The Anne Arundel County Sun to complain that as soon as the investigators left, he was stuck lying in soiled sheets, waiting for a nurse to arrive. His story was echoed by Keith Stickland, a Severn man who said his father was neglected more than once.
None of the incidents poses a serious, immediate threat to the patients' safety, Benner said. But the continuing problems "seriously limit the facility's capacity to furnish an adequate level of care," she wrote in the letter.
If the center's 11th-hour attempt to improve care fails, the administration can appeal the state recommendation for terminating its Medicare and Medicaid certification. The nursing home could remain open during the appeal, but the Health Department also could restrict or revoke its license, Benner said.