Nursing facility in Boise put vulnerable residents at risk, state inspection says

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A nursing home facility in Boise failed to provide quality care and pain management for its residents, and could lose its Medicare and Medicaid agreement if it fails to pass a follow-up inspection before Oct. 2, according to state and federal records.

The Centers for Medicare and Medicaid Services (CMS) served a notice to Cascadia of Boise, a skilled nursing facility, earlier this month after complaints drove a state inspection that found several deficiencies.

Cascadia put at least three residents at risk of seizures, diabetic coma, urinary pain and medical complications, the Sept. 10 survey obtained by the Idaho Statesman concluded. It also neglected to supervise residents as a safety intervention and provided inconsistent treatment for wounds, the survey said.

The facility has submitted a plan for corrective action, according to the Idaho Department of Health and Welfare. If the Idaho Bureau of Facility Standards accepts that plan, it can schedule another follow-up survey before Oct. 2, when Cascadia would lose its CMS agreement.

In an emailed statement Friday, Cascadia’s Corporate Affairs Director Steve LaForte confirmed it submitted a plan of correction to the state to comply with federal standards.

“As an organization, we are confident in the care that our hardworking staff provides achieving that compliance, and we are fully supporting them in making that happen in these difficult times of crisis when maintaining access to care is crucial,” LaForte said.

If the facility fails to pass the new inspection, it would no longer be reimbursed by CMS for its services. Nursing homes typically rely on federal money for most of their reimbursement, Idaho Health and Welfare spokesperson Greg Stahl said. Stahl said the unannounced visit would need to be conducted before Oct. 2.

LaForte said Cascadia serves 41 residents and is reimbursed by a mix of Medicaid, Medicare and privatized Medicare.

‘Two cooks in the kitchen’: Survey found inconsistent wound care

CMS said the survey showed Cascadia no longer met federal standards to provide quality of care and pain management.

The survey inspected care for 12 residents. Of those, inadequate care was found for three. The survey found that the facility failed to provide insulin at the right time to residents with diabetes — putting those residents at risk of seizures, diabetic coma, and other complications with extreme blood sugar levels.

Residents with full bladders who struggled to urinate were also left without catheters, which fails to follow Cascadia’s own policy, according to the survey.

The survey also pointed to the lack of communication or coordination on residents’ treatments. One resident had pressure ulcers. Those wounds were inconsistently treated with different orders from two authorities, the hospice agency and the medical director.

Cascadia’s wound physician told the state he didn’t personally see the resident’s wounds and didn’t give the orders. He said he wasn’t sure about the process for how orders were communicated or coordinated. In another interview, the medical director said the facility relied on the wound care nurse and wound care physician.

When the hospice physician was interviewed, he said he signed the hospice’s plan of care but never assessed the wounds personally. The physician told the state there were problems because there were “two cooks in the kitchen.”

In another deficiency, the survey said the facility failed to properly supervise residents, or provide devices to keep track of them, as a safety measure, according to the survey.

One document noted that a resident prone to wandering went into a ventilator unit and was touching equipment, undressed in other residents’ rooms and used their bathrooms. The facility’s policy states that interventions must be made once a resident elopes, or leaves the facility without permission.

The termination notice said that Cascadia was informed of deficiencies earlier this year, after surveys in April and June.

CMS said termination means that it would not pay for any services to Cascadia’s patients admitted on or after July 6. CMS would pay for the patients admitted before that date through 30 days after Oct. 2.

“We warned that unless your facility achieved substantial compliance before Oct. 2, 2021, we would terminate your facility’s Medicare Provider Agreement,” CMS said.

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