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The Summerville at Potomac assisted living facility in Potomac is no longer operating under a "directed plan of correction" imposed by the state Department of Health and Mental Hygiene in December, according to DHMH officials.

The plan of correction, along with a $10,000 fine, was imposed after a routine survey uncovered problems at the facility that regulators said jeopardized resident safety and violated state regulations. In a December report, state health officials noted that a full-time delegating nurse — a registered nurse who routinely monitors each resident, acts as a "traffic controller" and issues directives to the staff regarding health care — had not visited the facility since August. Minimum state regulations require a delegating nurse to assess each resident every 45 days, according to the health department.

Rueben Rosenfeld, executive director of the facility, said that during the time the facility did not have a full-time delegating nurse, it was visited by other RNs and actively recruited for the delegating nurse position. But those nurses did not act as a "delegating nurse" by assessing every resident, said Wendy Kronmiller, director of the DHMH Office of Health Care Quality, in January. According to Kronmiller, the lack of a delegating nurse contributed to situations including improper treatment of pressure ulcers, some severe, and improper monitoring of residents prone to falls.

As of last month, however, the correction plan is no longer necessary after the assisted living facility responded to the concerns highlighted in the state's correction plan, Kronmiller said.

"[Summerville has] really accepted the challenges on their own volition," Kronmiller said. "We will continue to monitor Summerville, as we do other places, but we are pleased with the steps they've taken and the progress they've made."

The plan directed Summerville to 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 plan also imposed an admission ban for residents with wound care concerns.

Summerville notified families of the plan, contracted with a wound care specialist and a monitor, and appointed a full-time delegating nurse in December.

The monitor was required to report to the state and the county about progress at the facility every 10 days, and the wound care specialist assessed each resident for wound care concerns and reported their findings to the state and the county every 10 days.

In March, the health department reduced the number of visits and reports required from the monitor to once a month, and also reduced the number of reports required from the wound care specialist to two times per month. Late last month, Kronmiller informed Rosenfeld that while the facility would continue to be evaluated as with other assisted living facilities in the state, the monitors were no longer necessary.

"[The monitor and wound care specialist] were for a significant amount of time required to be in the building and required to let us know what they found, and you saw a gradual arch of improvement over those months," Kronmiller said.

According to Terri Price, a regional director of sales and marketing Director of Sales and Marketing for Emeritus Assisted Living, the national network of assisted living facilities to which Summerville belongs, the facility now has two delegating nurses who complete an assessment of residents every 45 days. The facility has also hired a medical director.

"As a provider of services, you always want to exceed the expectations of your customers.  It has been our goal to work closely with our county and state surveyors to do just that. Summerville was very willing to put any measure in place to address their concerns as well as systems to prevent future concerns. We are very confident that we have done just that as a result of the most recent monitoring visit," Price wrote in an e-mail to The Gazette.

Kronmiller said to her knowledge there was no one currently at the facility with pressure ulcers or other wound care concerns except for one resident who is prone to pressure ulcers. Kronmiller said she was now confident that care could be coordinated to meet his needs.

"We will keep a steady eye on them to be sure this does not happen again, but I do think they've put a lot of energy and resources into fixing these problems," Kronmiller said.