TN Health Adds Assisted Living Citations to Monthly Reports

By Walter F. Roche Jr.

Tennessee health inspectors recently cited 33 assisted living facilities and fined them a total of $50,250 for a variety of violations including failure to transfer a patient who needed a higher level of care  to an appropriate  facility.
Nearly all the violations were recorded between May and September of this year, according to department officials. 
The listing of assisted living violations was included for the first time in a monthly report issued last month by the state health agency. Tennessee currently has 16,252 licensed assisted living beds.
According to spokeswoman Shelley Walker, the department decided to include citations imposed on health facilities in addition to the usual listing of disciplinary actions against individual health care professionals ranging from physicians to dentists to physical therapists.
Walker said the decision to add health facilities was not a result of increased scrutiny on assisted living facilities, but as part of an effort at increased transparency. Though the citations are being publicized and posted on the internet, residents seeking the actual inspection reports that resulted in those citations must file a request and pay a 15 cent per page fee for copies.
Among the facilities cited were major chains including Elmcroft, a Kentucky based operator, and Emeritus, another national provider with assisted living services at multiple locations.
Five Emeritus facilities made the list as did three run by Elmcroft.
Emeritus, earlier this year merged with Tennessee based Brookdale Senior Living, which also had one of its facilities, Clare Bridge of Cleveland, on the citation list. The $2.8 billion merger closed last summer.
Elmcroft of Lebanon was fined $1,000 after it "failed to identify the need for a higher level of care for a resident who developed an unstageable ulcer."
Also cited were Elmcroft of Halls (Knoxville) which was fined $500 for failing to administer medications ordered by a physician and Elmcroft of Twin Hills (Madison) fined $1,000 for failing to securely store medications and unsanitary dietary conditions.
The Emeritus facilities were fined by amounts ranging from $1,000 to $2,500 for a variety of violations including failing to document proper care plan revisions for a resident with multiple falls, failing to ensure medications were administered by a licensed professional and failure to properly store medications.
Clare Bridge of Cleveland was fined $1,000 for failing to review and revise a patient's care plan.
The largest penalty, $5,500, was imposed on Lafollette Court Assisted Living (Lafollette) for multiple violations including failure to secure medications, failing to maintain resident progress notes and failing to include physician's orders in patient records.
Rose of Sharon's Senior Villa in Chattanooga was cited for allowing the continued stay of a resident who exhibited verbal aggressive behaviours which posed a threat to others." The facility was fined $2,500 for that and other violations including failure to ensure that medications were administered by a  properly licensed professional.
Walker said there are no immediate plans to add state inspectors, who also handle the review of other licensed health facilities such as nursing homes.
"While we have worked hard to fill our vacant positions over the past couple of years we have not recently added any new positions for surveyors," Walker said.

Good morning Wally.

There has been no new or additional effort to look at assisted care living facilities any more closely than ever, and while we have worked hard to fill our vacant positions over the past couple of years we have not recently added any new positions for surveyors.  Our Office of Health Care Facilities has been recommending civil monetary penalties on ACLFs for a number of years.  CMP and consent order information for ACLFs have not been included in the Disciplinary Action Reports in the past because the requirement for issuance of DARs is found under the Health Professionals statutes and does not apply to facilities.  However, the department decided this year to include health care facilities in these reports in an effort to be more transparent.

The facilities that were placed on the DAR for September 2014 were files received after the May 2014 Board for Licensing Health Care Facilities meeting, with the exception of some that were carried over from May.  All of these cases originated from surveys in 2013 and 2014. 

Tennessee currently has 16,252 ACLF beds.  The numbers of ACLFs and ACLF beds in Tennessee has increased in recent years. 

Woody is out at a meeting today and asked me to work on this for you.  I’ve requested the Elmcroft files for you and am looking into your other questions.  I can tell you we currently have 262 ACLFs in Tennessee.  You can pull up the list at http://health.state.tn.us/HCF/Facilities_Listings/facilities.htm.