Two of the three nursing facilities with the most violations in Shawnee County last year are under new management that promises major changes, and the third has gone out of business.
The Legacy on Tenth Avenue had 56 violations recorded in four inspections, Washburn Community Care Center had 44 violations across seven inspections and Tanglewood Nursing & Rehabilitation had 27 violations across three inspections.
Washburn Community Care Center's residents were told in mid-May that they would have 60 days to move because the state couldn't find someone interested in running the facility. Former owner Deseret Health Group ran out of funds and couldn't make payroll, forcing the state to step in so residents would continue to receive care before transferring.
Although the shutdown wasn't related to quality issues, Washburn Community Care Center had a history of them. Seven of the 44 violations in 2014 were high-risk, and the facility had had 32 violations in 2013.
Tanglewood making changes
HMG Services bought the former Westwood Manor in June 2014 and renamed it Tanglewood. Administrator Kim Smith joined in December. Nine of the 27 violations happened under the previous owner.
Jeanne Dillon, vice president of marketing and business development for HMG, said the company has done renovations to the building, including roof repairs, improving the therapy gym and adding new windows and an outdoor sitting area. The living room area has new furniture and the bathing area has been changed for easier use, Smith said. They will work on resident bedrooms as they become vacant.
New electronic health records make it easier for staff to keep up on resident needs, and the new medical director and director of nursing are working to improve communication with residents, families and doctors, Smith said. For example, staff are learning not just to look at vital signs, but to get to know residents and flag unusual behavior that could point to an underlying issue, Dillon said.
"Our job is to look for early warning signs," Dillon said. "For example, a patient might go to the dining room every day without fail and decide one day they don't want to go."
Dillon said the company also has taken steps to better train staff and improve resident satisfaction and gives staff incentives to go "above and beyond" for residents, with $100 gift cards and the chance to win a car at the end of the year. Other changes include switching to a silent paging system, she said.
"It has reduced the noise tremendously, to the point that residents are saying they can sleep," she said.
Violations in 2014 included not preventing pressure sores, which resulted in one resident losing a toe; dirt and an odor of urine in bathrooms; not notifying a resident's family when he or she was taken to an emergency room; limiting when residents could access funds; failing to investigate disrespectful behavior by staff, including placing a chair and table around a resident with a wheelchair to box him or her in; not properly monitoring the effects of certain medications; paperwork issues; and not dating all foods to keep track of when they would expire.
Dillon said the facility has made progress and is continuing to improve. When a reporter visited Monday, the facility appeared clean, and residents seemed familiar and comfortable with Smith.
"A building that's broken is not going to change overnight," Dillon said. "It's a never-ending process."
Smith said she has seen residents take greater pride in keeping the facility in good condition, such as asking others not to bring food into the living room, where it could be spilled on the new furniture. The culture also is becoming more centered on residents' needs and preferences, she said.
"As employees, we're guests in their home," she said.
Changing Legacy
Willie Novotny bought The Legacy on 10th Avenue in May 2013 with a partner. From the beginning, it was clear the building's physical infrastructure and culture both needed work, he said.
The facility didn't have any sort of electronic health record, meaning staff had to search through paper records to find information about residents, and the intercom system of paging staff could make for an unpleasant atmosphere, Novotny said. Under the new system, staff can use kiosks mounted on the walls to enter resident data and get information about calls for service through walkie- talkies, he said.
Novotny said he and the new administrative team replaced all but "less than a handful" of staff in 2013 and 2014. Most of the staff at that time didn't have a "service" mentality, and were too focused on telling residents what to do, he said.
The new model emphasizes resident rights, including making choices about when they want to get up, eat and bathe, Novotny and administrator Shyla Buxton, who joined the facility after he purchased it, said. They also invite residents to twice-monthly meetings about The Legacy's culture and have involved them in decisions about painting the previously uniformly white walls, Buxton said.
"Our standard is that this is their home, they make the rules and we do everything on their terms, Novotny said.
Novotny and Buxton said more training for staff has been a priority. For example, even certified staff have to show that they know how to perform care and undergo training if their memory is fuzzy or they picked up "bad habits" while working at another facility, Buxton said.
Novotny said he estimated it would take about three years to "stabilize" the facility, make cultural changes and move forward. In the future, he plans to make improvements to the existing building, which dates to about 1960, and to build a new independent living facility on the adjacent three-acre plot, he said.
Violations at The Legacy in 2014 ranged from a smell of urine in hallways and broken glass on a beauty shop floor to a lack of background checks on employees, not providing residents showers when needed, avoidable pressure sores and falls, errors in medication doses, improper sanitation of surfaces residents touched, problems documenting how residents' money was handled and other paperwork issues. Staff said it wasn't unusual for residents to wait 30 minutes for assistance when they turned their call lights on.
Novotny said the number of violations isn't an indicator of quality, since most of those citations were low-risk, and some were paperwork issues. Eight of the violations were classified as high- risk. The 2014 numbers were an aberration, however, because the facility was replacing staff and updating systems at the same time, he said.
"Sometimes when you're replacing staff and systems, it results in a bad survey," he said.
Novotny said he expects far fewer violations this year, and pointed out the Kansas Foundation for Medical Care has recognized the facility for improvement already. When a reporter visited Wednesday, the facility appeared clean, and Novotny and Buxton sometimes paused the tour to address a resident's needs before moving on.
"Going from where we were last year to getting that first rung and being recognized for quality, we're very proud of that and we expect to keep climbing the ladder," he said.