Legacy nursing home in Hilo hired a former state Department of Health nursing home compliance director to get Legacy back in line with federal regulations.
The latest inspection at Legacy shows continuing deficiencies in care.
If Legacy hasn’t corrected them, it will lose its Medicare certification March 19 — just more than nine weeks from now.
Ben Meeker, a co-owner of the facility, said Legacy hired Dianne Okumura “to head its compliance efforts,” and she already began the task.
“Ms. Okumura served the Office of Health Care Assurance for 35 years in various capacities, including chief of the department and head of the licensing section,” Meeker said in an email to the Tribune-Herald. “Legacy Hilo is confident that all outstanding licensing issues will be resolved.”
While the nursing home can still accept new residents, on Dec. 19, federal authorities imposed a penalty that denies Medicare and Medicaid payments to the home for housing those newly admitted residents.
Inspections have repeatedly shown Legacy deficient in its care of residents. Its most recent inspection showed continued problems with the care categories termed “administration” and “quality of care.”
The Hawaii Tribune-Herald made inquiries after obtaining a copy of the latest inspection, dated Dec. 16, 2016, from the Centers for Medicare and Medicaid Services.
That inspection quotes a nurse, whose job duties included tracking falls. The Legacy staffer told inspectors that Legacy residents experienced 17 falls in the first 15 days of December.
Nursing homes are supposed to develop care plans to prevent falls, especially for residents at risk.
When a fall happens, nursing homes are supposed to analyze the event, determine a root cause and create a plan to prevent future falls.
When multiple residents fall during the course of days or weeks, nursing homes are supposed to recognize the pattern and brainstorm new, more effective ways to prevent additional falls.
Legacy only received three citations for deficient care during its most recent inspection, a significant improvement from its past two inspections — 27 deficiencies in September and 16 in November.
Officials from the nursing home and the state Department of Health noted that the decrease in deficiencies was a good sign. However, the three citations for deficient care in December were in the same categories of care as the previous two inspections, said Jack Cheevers, public information officer for the San Francisco region of CMS, which monitors Hawaii nursing home inspections.
That’s bad for residents because it indicates they remain at risk.
And it’s bad for the nursing home because it means Legacy will continue being assessed daily civil penalties, must create new plans of correction for the deficiencies in care and its risk of losing its Medicare certification will continue.
But Meeker said Okumura helped write Legacy’s latest plan of correction “and has been working both on-site and off with the staff.”
Janice Okubo, DOH communications director, said there’s no conflict of interest when a nursing home hires a former employee of the department.
Okumura “retired from state service with the Department of Health more than eight years ago and at this time she has no authority over the licensing program or its staff,” Okubo said, noting the department “will continue to work with the facility directly to meet federal and state requirements for licensing and certification.”
The latest Legacy inspection report notes one resident who fell suffered a severe head injury, illustrating why state surveyors, who inspect nursing homes under contract with the federal government, pay so much attention to problems with care, such as falls.
The three areas in which Legacy has remained deficient in care from September through December include:
• Quality-of-care — resident physical, mental and psychosocial well-being.
• Quality-of-care — prevention of accidents; assistance to residents and interventions.
• Administration — failure to maintain a program to prevent falls.
If the nursing home had corrected those, it would have been considered back in compliance.
But because the same deficiency categories continue long-term, CMS imposed penalties, including a $2,353 civil penalty per day starting Nov. 11 (an increase from a $1,953 civil penalty per day starting Sept. 19).
The per-day civil penalties and lack of payment for new admissions “will continue until the facility is back in compliance or is terminated from the Medicare/Medicaid program on 3/19/17 if it does not correct deficiencies and come back into compliance,” Cheevers wrote.
He said CMS hasn’t said how much the continuing fine will be after the December re-inspection.
Surveyors who inspected legacy in December wrote that Legacy failed to analyze “recurring falls” and find root causes. In addition, there were “no improvement processes implemented to ensure safety from falls.”
Inspectors also wrote about a resident whose medicine, to prevent infection after an invasive procedure, was repeatedly unavailable. They said the resident “suffered harm due to the neglectful action, as staff failed to provide medication.”
According to a letter received by CMS, 51 percent of Legacy is owned by Hawaiian Islands Regional Center LLC and Meeker owns 17 percent.
Listed as owning 5 percent or greater “direct ownership interest” (with no percentages listed) are Regency Venture Fund LLLP, Marvin Beddoe, James Clay and David Stroud.
Cheevers said Andre Hurst (founder of Hawaiian Islands Regional Center) and Meeker currently control decisions about the facility’s operations.
Email Reporter Jeff Hansel at jhansel@hawaiitribune-herald.com.
