Vista Grande in compliance with standards

Vista Grande in compliance with standards

Dec. 14, 2000

By Jim Mimiaga
Journal Staff Writer

The Vista Grande nursing home is back in compliance with federal care requirements it had violated during an unannounced inspection last summer, the Department of Health and Environment has reported.

In July, inspectors found seven deficiencies at the 78-bed home after randomly picked patient cases were analyzed. One deficiency was overturned, and another’s severity level was reduced following an appeal process.

Management was mainly faulted for not having sufficient comprehensive-care plans for residents at the nursing home, a requirement under state law. Vista Grande is operated by Continuum, LLC., a health-management company based in Greeley under a lease agreement with the district.

A follow-up inspection showed the problems had been fixed.

"They were back in full compliance after we completed the re-visit," said Jean-Marie Reagan, a Department of Health nursing-home inspector.

Debbie McWilliams, Vista Grande’s new administrator for Continuum, said Tuesday that the problems cited were exaggerated, explaining that care standards were in compliance, but that paperwork overlooked by staff made it appear as if they were not.

"The care given is excellent, but it was not always written down. A lot of it was documentation issues, and we have just thoroughly revamped the entire care-plan process," McWilliams said. "(The information) was in the nurses’ notes but it wasn’t always in the care plan. Now it is."

McWilliams emphasized that when nurses were interviewed by inspectors, they showed awareness of the problems and how to address patient needs, despite the lack of documentation. Also, the care-plan process had already been identified as an issue and was undergoing review for improvement at the time of the inspection, the reply stated.

"I think there was a lack of understanding how important it is to actually write it all down," McWilliams said.

Of the deficiencies, one was rated as an A, a relatively minor problem, and four were considered to be Level D, meaning they had the potential for causing more than minimum harm to the patient. The worst offense cited during the inspection, a Level E — meaning there is a widespread problem affecting multiple residents — was for the facility’ lack of adequate care plans for some clients.

The scale runs from A to L, with A being a minor problem and L meaning the resident is in imminent danger.

Vista Grande submitted a plan of correction for the problems cited in the report. New care plans for each patient were drawn up, and improved procedures for reviewing and updating them have been implemented, McWilliams said.

The unannounced July inspection showed that several patient-care plans were incomplete.

For instance, one woman’s care plan did not address her combativeness during bathing, dressing and eating, and her resistance to receiving needed care; another woman was not wearing a leg brace when she should have been and no schedule clarifying when it should be worn was recorded; and another had frequent falling problems that were not noted in the comprehensive-care plan.

Vista Grande challenged the report’s assertion that a woman’s sudden weight loss was an indication of deficient care. According to the plan of correction, the woman’s self-imposed dieting was within the scope of her resident rights. The plan noted that the patient was above normal weight and is "alert and orientated and able to make the decision for herself."

Regarding a woman who was seen eating breakfast without her leg brace and tennis shoes on as required when out of her room, officials claimed the resident’s range-of-motion problem was being successfully dealt with through consistent physical therapy. She was without the brace because she had just received a bath and was taken directly to the dining room so as not to miss breakfast, the report said.

A sign above the patient’s bed stating that the brace was needed for all transfers and meals was to be changed.

The resident with a tendency to fall frequently would be better monitored in her care plan to prevent falls in the future, according to the plan of correction submitted.

The inspection report’s initial conclusion that pharmacy recommendations were not being followed was overturned after the Level D deficiency was challenged by Vista Grande officials. The challenge successfully showed that pharmacy reports are acted upon, although the pharmacist’s latest report was not responded to until the surveyor raised the concern. The severity was reduced to a Level A, meaning there was potential for no more than minimal harm.

Regarding a concern about whether a woman had the capacity to self-administer drugs, Vista Grande officials responded that the drug in question, Vitamin E, is considered a nutritional supplement rather than a medication. Whether patients can safely self-administer drugs would be more closely scrutinized at any rate, Vista Grande officials reported in their response.

The report cited the home for failing to keep residents free from unnecessary drugs. In the case highlighted by the health report, a woman’s use of a sleeping pill was called obviously ineffective after prolonged use; therefore the need for the drug should have been better evaluated, the report said.

In response, Vista Grande developed a new policy and procedure to ensure that each resident is not taking drugs that do not work or aren’t needed. The procedure includes more checks and balances between physicians and nurses who order and administer medications to insure there is adequate indication for its use.

Also, a medication-review committee was formed and a new pharmacy consultant has been brought in to monitor medication distribution better.

McWilliams said the home provides patients with education on matters regarding nutrition and medication, but that if a cognizant resident refuses the recommendation, this is within his or her rights.

"You can’t force it down them; they have the right to refuse," she said, adding that the industry also struggles with the dilemma of being safe by restricting movement of patients with physical limitations, but at the same time not prohibiting independence and mobility.

"It is a tough line to walk," she said. "That independence is important."

Vista Grande is a publicly-owned but privately managed long-term-care facility that is a part of the taxpayer-supported Montezuma County Hospital District.