Apr. 6—TRAVERSE CITY — Grand Traverse Pavilions CEO Rose Coleman was in the hot seat as county commissioners questioned her for more than an hour about 20 citations the facility got last year.

More precisely, commissioners wanted to know why they, the public, or Commissioner Penny Morris, the county liaison to the Department of Health and Human Services board, were never told of the citations at the county-owned Pavilions.

"The problem is that we don't know, there's a lack of transparency," Commissioner T.J. Andrews said.

Coleman and DHHS board members Cecil McNally and Gordie LaPointe were invited to Wednesday's county meeting to report on the citations. Coleman has said most of the violations were related to food service by a company that has been replaced.

Board members found out about the problems at the facility through a Record-Eagle report published Feb. 8, Andrews said.

Andrews said she did not see anything about the citations in minutes from several DHHS meetings held from August through mid-February.

The citations were not publicly discussed until a Feb. 23 DHHS meeting, according to minutes.

"There are significant issues that go far beyond food service and it concerns me that they were not discussed until six months after DHHS issued the violations," Andrews said.

Coleman said the report, which was received Aug. 19, was never discussed in an open DHHS board meeting or in a closed session.

A plan of correction was submitted to the state by Coleman on Aug. 27. Plans of correction must be submitted to the state within 10 days.

When questioned, Coleman said the inspection report and plan of correction was previously emailed to board members.

The plan says that training must be given to all staff members that provide direct care to patients or enter a patient's room for any reason.

Board members had signed off on the plan during a closed session, even though Coleman said the citations were not talked about in a closed session.

She said board members are aware of what plans of correction are as they've signed them before.

"We didn't go through the inspection in closed session," McNally said.

Coleman brought the plan of correction to them to be signed, he said, "But we didn't actually go through the whole 96 pages until February."

McNally said there other things going on that got in the way of discussing the report, such as a lawsuit filed by a former PACE North executive.

Neither the citations or plan of action are posted on the Pavilions website, Coleman said. She said they didn't need to be because they are posted on the Centers for Medicare and Medicaid Services website.

Annual inspections, or surveys, are federally mandated for any facility that receives Medicaid and Medicaid dollars. The August inspection was done by the Bureau of Survey and Certification through the state Department of Licensing and Regulatory Affairs.

A letter received from LARA dated Aug. 19 informed Coleman that Pavilions did not meet federal requirements by the CMS, and that as of Sept. 3 payment for all new Medicare/Medicaid clients would be denied.

The restriction was lifted on Sept. 9 when it was found that Pavilions corrected its deficiencies. They were notified by another letter dated Nov. 2.

The Aug. 19 letter also informed Pavilions that they would not be allowed to have in-house nurse's aide training until Sept. 2024. Coleman said Pavilions has not been able to offer the training since 2019, but partners with a program off campus.

Health inspections are typically done over four days and consist of observations, interviews with residents and staff and reviews of patient records.

Sisters Andrea Gerring and Claudia Bruce, who are regular attendees of DHHS meetings, both spoke during public comment at Wednesday's county meeting.

Gerring said Coleman's "carefully choreographed" reporting has misled the DHHS board for years, causing harm to the Pavilions.

Bruce said Wednesday's report to the county board was also misleading.

"In it she dares to diminish the significant heartbreaking and unprecedented 97-page survey report by describing it as 'some care issues and dietary issues,'" Bruce said.

The 2022 inspections found residents waiting for breakfast or sleeping through meals, residents who were losing weight or had pressure sores or were not assisted to walk in the halls as ordered by a physician.

One incident of non-consensual sexual contact in July was self-reported by Pavilions.

"There were things in that report that just shouldn't have happened," McNally said.

Residents said there are not enough activities for them. Activities stopped during COVID, but state and federal guidelines were loosened in August, Coleman previously said.

Several citations were as a result of poor food service, including rotting, moldy and expired food; dirty pots, pans and floors; an understaffed kitchen and employees not familiar with food safety standards.

A food service contract with Unidine was terminated. A new company, Forefront Healthcare, will start April 13 and has already been on site to inspect the kitchen, which will get a deep clean and some new equipment. The company has also hired nearly all of the Unidine staff and is doing some training.

LaPointe said he has been on the DHHS board for two years and before that he was the county commission liaison for to the board for two years. He said Pavilions staff, including Coleman, has always been forthcoming.

"I've found no occasions where they've shielded things from us, they've been forthright and extremely responsive, and that's all I can ask for," LaPointe said.

LaPointe called last year's inspection an "outlier," but information at the CMS website shows the facility received 39 citations over the last three years.

Rating stars, up to five, are based on staffing and quality measures, in addition to the health inspection. The Pavilions currently has a two-star rating.

Coleman told the board that getting back to a four- or five-star rating will take at least two years, as the health inspection portion of the rating is weighted over three years.