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The Summerville at Potomac assisted living facility has cited hiring problems after state regulators found that the facility did not have a delegating nurse at the facility since August, which regulators say jeopardized resident safety and violated state regulations.
The finding was included in a 54-page "Statement of Deficiencies" issued from the state Department of Health and Mental Hygiene to Reuben Rosenfeld, executive director of the facility, in December following a routine survey. According to minimum state requirements, a delegating nurse — an RN who routinely monitors each resident, acts as a "traffic controller" and issues directives to the staff regarding health care — must visit the facility every 45 days.
"In a challenging health care field, we actively recruited for the delegating RN position," Rosenfeld wrote in an e-mail to The Gazette.
Rosenfeld said that during the time the facility did not have a full-time delegating nurse, it was visited by other RNs. But those nurses did not act as a "delegating nurse" by assessing every resident, said Wendy Kronmiller, director of the health department's Office of Health Care Quality.
The facility houses 108 residents, with 16 in a memory care unit.
The state report outlined health care concerns at the facility including the improper treatment of pressure ulcers and improper monitoring of patients prone to falls, which Kronmiller attributed to the lack of a delegating nurse. One woman in the memory care unit sustained an infected pressure ulcer with heavy greenish-yellow discharge that was emitting a foul odor, according to the report. The woman was one of six patients who did not receive proper care for pressure ulcers, the report stated.
A full-time delegating RN has been onsite since Dec. 8, according to Rosenfeld, along with weekly visits by Jeff Gruber, a delegating nurse and Regional Director of Quality Services for Emeritus Senior Living, the national network of assisted living facilities to which Summerville belongs.
The state imposed a $10,000 fine and outlined a six-point "directed plan of correction" in the report, indicating that Summerville must appoint a full-time registered nurse; examine the skin of each patient and report the findings; enlist a wound care specialist to address ulcer concerns; operate under a monitor that will report to officials; and notify residents and their families about the survey. The correction plan also included an admission ban at the request of the county. However in an "Official State Clarification Letter" issued to the facility after the report, Kronmiller wrote that the ban only applied to patients "needing wound care or at risk of requiring wound care."
Summerville contracted Dec. 17 with wound care specialists recommended by the state, according to Gruber. "They are here overseeing our actual skin assessments," Gruber said. Summerville also enlisted the services of a monitor Dec. 18, and sent a letter about the survey to residents and their families Dec. 19.
Kronmiller acknowledged in the letter that the facility has begun using a delegating nurse, though she wrote "The Department remains concerned… about the lapse in nursing care and presence over a number of months. There is significant nursing ‘repair' work to accomplish and pending this work, individuals remain at risk."